European Journal of Cardiovascular Medicine

A significant public health issue in both developed and developing countries is substance abuse.^1,2 Substance misuse is a problem everywhere in the globe today. It also affects India, particularly among teenagers, where the number of substance users is rising daily.3 Throughout India's history, the use of various drugs has been common for ages.⁴ Alcohol was the first substance utilized, having been used as early as 2000 BC. For ages, opium and cannabis have been widely used in various countries.⁵ India's economy has grown faster over the past ten years. Significant societal changes have also occurred in India as a result of economic reforms, international travel, and exposure to Western media, advertising, fashion, and lifestyle. Teenagers are said to have changed their leisure pursuits as a result of this.⁶ Despite India's progress toward the Millennium Development Goals, the health sector is making less progress, particularly in the area of adolescent health.⁷ The door-to-door survey method has been used in numerous surveys to address the prevalence of substance use in India.⁸ In India, very few community-based research have been carried out to determine the prevalence of substance use. This research intended to shed light on the issues surrounding substance use in the community. Adolescent males in the urban slums of Navi Mumbai region of Maharashtra participated in a community-based cross-sectional study to determine the prevalence of substance use among them and the factors linked to it, as there is a dearth of information on the pattern and factors associated with substance use in the community.

Between March and November 2024, Community Medicine department of a tertiary care teaching hospital in Navi Mumbai conducted a community-based cross-sectional study to determine the prevalence of substance use among adolescent males in an urban slum. Households located in the field practice area of an urban health centre of Community Medicine department were selected as study population. Substance use refers to the use of selected substances, including alcohol, tobacco products, illicit drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body with possible dependence and other detrimental effects.⁹

A prior community-based study among adolescents in India with a prevalence of 33.8%, served as the basis for calculating the sample size.¹⁰

Applying the equation n = 4pq/d2

The sample size was determined to be 246 with p = 0.33, q = 0.67, and d = 6% absolute precision.

Simple random sampling was adopted for selecting the participants. Computer generated random number table was used for selection of the households. All adolescent boys between the age group of 10 to 19 years who had lived in the randomly selected family in the neighbourhood for previous 12 months and provided their written informed consent or assent were included in the study.  The next house was chosen if male adolescent fitting the inclusion criteria was not available. The lot technique was used to select one participant if a house had multiple eligible participants. The participants were given an explanation about the aims of the study. Adolescents who were under the age of eighteen and whose parents or legal guardians were unable to provide their consent were excluded. Also adolescent females and those unable to communicate because of physical or mental impairments were excluded. Approval for conducting the study was obtained from the Institutional Ethics Committee.

An interviewer administered structured questionnaire was used to collect data. The Youth Risk Behavior Surveillance System (YRBSS) and Car, Relax, Alone, Forget, Friends (CRAFT) survey served as the main sources for formulating a pre-tested, semi-structured questionnaire.¹¹ The questionnaire was translated from English to local language by two bilingual translators and then back to English by two more bilinguals to ensure that the questions were understood.

The data was entered using the Epi-Data software (version 3.1), and Open-Epi software was utilized for analysis.  The descriptive statistics involved the prevalence of substance use.

To analyze the factors linked to substance use, a chi-square test and odds ratio (OR) with a 95% confidence interval (CI) were computed. To observe association between different parameters and substance use, a bivariate analysis was conducted.

Out of total 246 participants, majority of them belonged to age group 15-18 years, comprising 187 (76%) participants, while remaining 59 (24%) belonged to age group 10 to 14 years. On analysing occupation of head of family in the present study, it was observed that the majority of them were unskilled, comprising 158 (65%) participants, while 72 (29%) were skilled and 16 (6%) were unemployed. Education-wise analysis revealed that majority of the participants were school-going or had completed school education, comprising 162 (66%) total participants.

Out of total 246 participants, 216 (88%) were living as a nuclear family, while 30 (12%) were living in a joint family, as depicted in table 1.

Table 1: Socio-demographic details of participants in the present study.

Amongst substance uses, alcohol use was most common, accounting for 93 (38%) participants, followed by tobacco smoking in 76 (31%) participants, tobacco chewing in 51 (21%) participants, and Ganja (weed) use in 15 (6%) participants, as shown in figure 1.

Figure 1: Substance use in participants of the present study.

On analyzing the association of various factors associated with substance use, it was found that age group 15 to 18 year had 71 (38%) participants with some form of substance use as compared to only 3 (5%) in age group 10 to 14 years. This difference was highly statistically significant (p<0.001) with odds ratio of 4.68 with a 95% confidence interval of 2.56-11.9.

While determining association between education and substance use, increased prevalence was observed in school dropout participants, accounting for 10 (59%). 44 (20%) school-educated participants had ever used any substance while only 3 (38%) graduate participants gave history of substance use ever. The difference was statistically significant (p=0.03) with an odds ratio of 3.29 with 95% confidence interval of 1.07-7.2.

The majority of the participants with substance use were living in a nuclear family, comprising of 123 (56%) participants, while 6 (20%) participants lived in a joint family, as shown in Table 2. And it was observed that adolescents belonging to nuclear family had significantly high prevalence of ever using a substance compared to those living in a joint family. (P-value <0.001, OR=3.02 (1.99-6.4)

Table 2:  Association of substance use with various factors in participants.

Substance abuse remains a significant concern in both developed and developing nations.  The persistent cycle of substance abuse is increasingly affecting India, with daily rises in case numbers.⁸  Drug use typically initiates in adolescence; however, adolescent drug users are infrequently observed in treatment centers.  The issue of adolescent substance use remains a significant global public health concern, necessitating further research to ascertain the actual prevalence of substance use. Community-based programs are effective in preventing and treating substance abuse in children and adolescents.⁵

 In this study, 24% of adolescents were enrolled in high school, while 7% were dropouts.  This is in contrast to two studies conducted in the urban slums of Sambalpur, which reported that 52% of participants were school dropouts, and in Mumbai, where the figure was 44%.⁶ The low dropout rate may be attributed to the effective implementation of compulsory high school education in the state. 

Effective substance abuse prevention education necessitates a comprehensive curriculum that encompasses various educational stages, from elementary school to college.  Content that is suitable for various age groups guarantees relevance and comprehensibility.  Younger students may gain from education on healthy habits and self-esteem, whereas older students are capable of engaging in more comprehensive discussions regarding the consequences of substance abuse and strategies for maintaining a drug-free lifestyle.¹²

 Thirty-nine percent of adolescents were identified as current users of any substance, which included tobacco chewers (21%), alcohol drinkers (38%), tobacco smokers (31%), and ganja users (6%).  The findings align with a study conducted on adolescents in Vellore, Tamil Nadu, which reported a peak prevalence of tobacco use at 48%, with alcohol use following at 29%.¹⁰ In a study done by Daniel L et al., in adolscents in Delhi found that majority of them had substance use for alcohol accounting for 77% and alcohol in 12%.¹³

The average age of initiation for alcohol use and chewing tobacco was 15 years, while for smoking tobacco, it was 14 years, in contrast to the 12 years reported in a study conducted in government schools in Noida.¹⁴ Another study indicated that adolescents in the urban slums of Udupi district in Karnataka initiated smoking and alcohol consumption at an average age of 16.8 years.¹⁴ The current study findings corroborate with findings of the above-mentioned studies. Research in community settings indicates that adolescents who engage in substance abuse are at a higher risk of experiencing severe violence, marital discord, traffic incidents, sexual abuse, and antisocial behavior.¹³

Substance use disorder, classified as a treatable mental illness, can lead to various physical, psychological, psychosocial, and legal complications.  This imposes a considerable burden on the affected individuals and their families.  This may result in anxiety, depression, personality disorders, and schizophrenia. A range of mutual support programs offers effective community-based interventions and therapies to aid families and individuals facing substance use challenges.¹⁵

Therefore interventions which involve engaging family members to enhance their participation in the care plan, educating them on the detrimental effects of drugs, providing emotional support, and recognizing early warning signs of relapse are essential.

This study's community-based design and urban context impose limitations that may hinder its ability to accurately represent the entire population.  Due to the sensitivity of this topic, it is possible that underreporting has occurred. Though association was established causation could not be allocated to the identified socio-demographic characteristics related to substance use due to study design. Adolescent girls were also not involved in the study with purview of any unfavourable reactions from the family in the community.

This community-based study revealed a significant prevalence of current substance use, with alcohol use identified as the most commonly used substance among adolescents.  Therefore, it is essential to implement comprehensive prevention and control programs targeting teenagers and their parents within schools and the community.  Addressing this significant issue necessitates intervention activities that target the risk factors, adverse effects, and long-term consequences of substance use.

Source of funding: None.

Conflicts of interest: None.

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