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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 37
| Issue : 1 | Page : 41-46 |
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Substance use trends among undergraduate students and its association with sociodemographics and self-esteem
Ferdinand Banji Kumolalo Ph.D 1, Adetunji Obadeji M.B., Ch.B., M.Phil., F.M.C.Psych 2, Benjamin Olamide Adegoke M.B.B.S., F.M.C.Psych 1
1 Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
2 Department of Psychiatry, Ekiti State University Teaching Hospital, Department of Psychiatry, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| Date of Submission | 05-Jan-2023 |
| Date of Decision | 11-Feb-2023 |
| Date of Acceptance | 12-Feb-2023 |
| Date of Web Publication | 28-Mar-2023 |
Correspondence Address:
Adetunji Obadeji
Department of Psychiatry, Ekiti State University Teaching Hospital, Department of Psychiatry, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State,
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/TPSY.TPSY_5_23
Objectives: Earlier studies suggest that self-esteem is an important predisposing factor to substance use among young adults. In this study, we intended to determine the risk, patterns of substance use, and the association between self-esteem and substance use among undergraduate students. Methods: This is a cross-sectional study in a state university in Nigeria. The study university students completed a copy of sociodemographic questionnaire inquiring about their substance use and an assessment with the Rosenberg Self-Esteem Scale. Results: A sum of 448 students took part in the study. Among them, the odds ratio (OR) (95% confidence interval) of 198 (44.2%) students was found to be 0.442 (0.395–0.489) for a lifetime history of any substance use while OR (95% confident interval) of 141 (31.5%) students was found to be 0.315 (0.272–0.360) to have a history of current use of any substance. We also found that 182 students, i.e., 0.406 (0.360–0.453) and 118 students, i.e., 0.263 (0.223–0.307) had lifetime and current use of alcohol, respectively. This was followed by nicotine, tramadol, and cannabis. Participants who were 21 years and above, male, in third year and above, and who were not satisfied with their finances were significantly more to have a lifetime and current history of substance use (p < 0.05). There was no significant association between self-esteem and either lifetime or current substance use. Conclusion: The patterns of substance use in this study were similar to those obtained in the general population, however, with a relatively higher rate of alcohol use. Students with substance use were more likely to be males, older, have some financial difficulties, and low to normal self-esteem.
Keywords: alcohol use, drug abuse, epidemiology, substance-related disorder
How to cite this article:
Kumolalo FB, Obadeji A, Adegoke BO. Substance use trends among undergraduate students and its association with sociodemographics and self-esteem. Taiwan J Psychiatry 2023;37:41-6 |
How to cite this URL:
Kumolalo FB, Obadeji A, Adegoke BO. Substance use trends among undergraduate students and its association with sociodemographics and self-esteem. Taiwan J Psychiatry [serial online] 2023 [cited 2023 Jun 11];37:41-6. Available from: http://www.e-tjp.org/text.asp?2023/37/1/41/372642 |
| Introduction | |  |
Alcohol and drug use among young adults is a growing concern globally [1],[2]. Evidence exists that substance use and misuse are primarily problems of adolescents and growing adults. The use of different substances is associated with many adverse biopsychosocial outcomes, including their social support system [3],[4],[5],[6]. Among people aged 16–25 years, substance misuse has been reported as the leading cause of preventable death [2],[7],[8]. Besides, it is associated with poor academic performance, delinquency, road traffic accident, unwanted pregnancy, remarkable psychological and physical morbidities, including HIV infection, and adult harmful use or dependence [3],[5],[9],[10],[11],[12],[13]. It exerts a remarkable economic and social burden on the society, with the use of alcohol and illicit substances accounting for 14% of the total health burden [1].
Reports from various nations globally show the varying rates of substance use. Alcohol is the most common substance often abused by most young people [14],[15],[16],[17],[18],[19],[20], although this may be replaced by nicotine in some countries depending on the dominant religion [17],[20].
Surveys on substance use and misuse in the general population show that the rate of substance use among young people remains higher than the older population [21],[22] and the general population [21]. Globally, the rate of substance use is highest during the transition from adolescence to adulthood, i.e., between the ages of 18 and 25 years. The adolescence period is a critical risk period for the initiation or experimentation of substances, and the use of these substances may peak among young adults [6],[22]. The use of substances at this critical period of life often progresses to a more problematic use or substance use disorder and the development of associated co-occurring mental disorders [12],[13],[23].
Several factors influence the use of substances among young adults. Perceived ease of availability, perceptions of a low risk of harm, peer victimization, and other social and economic circumstances are important factors [17],[20],[24]. Besides, young people are usually self-focused and dynamic, with increased independence as well as changes in residence, relationships, education, and dire interest in exploring new things [17]. Previous substance use, family history of use, psychological distress or other mental health issues, and peer influence have been reported as the predictors of substance use [6],[22],[25]. Many reasons exist why young people use substances, most importantly to relax, become intoxicated, keep awake at night while socializing or surfing the internet, enhance activity or alleviate depressed mood, or a combination of these reasons [26].
Self-esteem is a personal construct expressing an individual approval or disapproval of himself, as well as a personal evaluation based on one's values [27],[28]. Low self-esteem has been reported to have a significant effect on mental health and may influence individual development as well as life outcomes, more importantly among young adults.
Various studies exist linking self-esteem with substance use, especially among adolescents and young adults [29],[30]. In this study, we intended to determine the hazardous risk and pattern of substance use, as well as to study the association between substance use and self-esteem among undergraduate university students at a state university in the southwestern state of Nigeria.
| Methods | | |
Design and setting
This is a cross-sectional study involving undergraduate students at the Ekiti State University, Ado-Ekiti, specifically, at the Faculty of Sciences and Humanities. The State University is located in Ado-Ekiti where attracts students from all works of life with diverse sociocultural, religious, and economic backgrounds, most especially from the southwestern region.
Sample size and sampling
We had 448 students that took part in the survey. The detail of how the sample size was determined can be found in our earlier study [31]. A sample of 440 participants was estimated for the study; however, 448 students were recruited through a systemic sampling from randomly selected departments.
The study protocol was approved by the Research and Ethical Committee of the EKSUTH, Ado Ekiti (protocol number = EKSUTH/A67/2019/12/008 and date of approval = March 12, 2019), with the stipulation of obtaining signed written informed consent from each participant.
Study instruments
Self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). It is a 10-item instrument with items answered on a four-point Likert scale – ranging from strongly disagree (1) to strongly agree (4) [32]. The total scores range from 10 to 40. Higher scores represent higher self-esteem. Psychometric assessment of RSES showed high internal consistency and reliability with a Cronbach alpha about 0.70 to 0.85 [33],[34].
Current substance use was assessed by asking “In the last four weeks, have you used any of the following substances?” likewise for lifetime use participants were asked: “In your lifetime, have you used any of the following substances?” We defined current substance use as the use of any psychoactive substances (excluding coffee) in the past four weeks while lifetime use connotes the use of substances anytime in one's lifetime.
Statistical analysis
We did descriptive statistics including frequency distribution, mean with standard deviation (SD), and bivariate analyses (Chi-square) to determine the association between substance use, socio-demographics, and self-esteem. A multiple logistic regression was used to determine the relationship between sociodemographics, substance use variables, and low self-esteem.
We analyzed the study data with International Business Machine Package for Social Study (SPSS) software version 24 for Windows (IBM Inc., Armonk, New York, USA). The differences between groups were considered statistically significant if p-values were smaller than 0.05.
| Results | | |
Four hundred and forty-eight students took part in the study. Their ages range between 15 and 34 years with 21.0 ± 2.9 (mean ± SD) years. Of these 352 (78.6%) had RSES scores within the normal limit while 59 (13.2%) and 37 (8.3%) had scores in the low and high range, respectively. A significant difference was found in the mean RSES scores across age group (those below the age of 20 years and those aged 21 years and above (t = −2.096, p < 0.05), and gender (t = −2.25, p < 0.05). A total of 36 (8.0%) were poly-drug users and significantly more were male (p < 0.001 or 21 years, and older (p < 0.05).
As shown in [Table 1], 198 (44.2%) students, i.e., 0.442 (0.395–4.89) (hazardous ratio) (95% confident interval [CI]) reported a lifetime history of any substance use while 141 (31.5%) students (0.315) (0.272–0.360) were current users. A total of 182 (40.6%) students, i.e., (0.406) (0.360–0.453) and 118 (26.3%) students, i.e., 0.263 (0.223–0.307) reported lifetime and current use of alcohol, respectively. This was followed by risk ratio (95% CI) of nicotine, tramadol, and cannabis with a lifetime risk of 0.085 (0.061–0.115), 0.069 (0.047–0.097), 0.064 (0.044–0.092) and current risk of 0.045 (0.027–0.068), 0.056 (0.038–0.084), and 0.049 (0.031–0.0730, respectively.
[Table 2] shows the relationship between socio-demographic and substance use variables. Participants who were 21 years and above (p < 0.001), male (p < 0.05), in third year and above (p < 0.05), and who were unsatisfied with their financial state (p < 0.01) were significantly more to have a lifetime history of substance use. Similarly, those who were 21 years and above (p = 0.001), male (p < 0.05), studying humanities courses (p < 0.05), in their third year or above (p < 0.01), or unsatisfied with their finances (p < 0.05) were significantly more to have current history of substance use. No significant association was found between either lifetime or current substance use and self-esteem. | Table 2: Relationship between sociodemographic, self-esteem, and substance use
Click here to view |
[Table 3] shows the relationship between sociodemographic, substance use variables, and low self-esteem using logistic regression. None of the variables significantly predicts low self-esteem among the participants. But adjusted odd ratio (AOR) (95% CI) for students from humanities were 1.344 (0.737–2.453), AOR (95% CI) of current users of alcohol was 1.214 (0.242–6.069), and AOR (95% CI) of those with a lifetime history of substance use was 2.209 (0.409–11.942) showed a higher risk of low self-esteem. Similarly, those who were older i.e., 21 years and above AOR (95% CI) 0.854 (0.465–1.568), were significantly less to be at risk of experiencing low self-esteem, compared with their counterpart who were younger. | Table 3: Logistic regression showing the relationship between socio-demographic, drug use variables, and self-esteem
Click here to view |
| Discussion | | |
Substance use and misuse have been described as developmental psychosocial problems with the onset of initiation and psychosocial problems occurring in adolescence and young adulthood [6],[13],[23],[24],[25]. Among this population, nearly half of the students had used one substance or the other, excluding caffeine. Alcohol represents the most substance of abuse with over 40% reporting lifetime use and about a quarter reporting current use. The rate obtained in this study is lower than what was reported in an earlier study in south-eastern part of Nigeria but similar to what was reported among undergraduates in the north-central part of Nigeria, Sudan and Taiwan [14],[15],[20],[35]. The level of current and lifetime use of alcohol reported in this study was higher than what was reported among undergraduate students in Kenya [19]. Differences in socio-religious practices may explain these variations. Although various studies across the globe had reported varying rates of substance use, alcohol remains the most common substance used by most young people, [13],[14],[15],[16],[17],[18],[19],[20],[22]; however, this may be replaced by a cigarette in some countries depending on the dominant religion [17],[20]. Alcohol has been reported as the gateway drug predating most other substances. The fact that alcohol is readily available and socially acceptable may explain this trend. Nonetheless, the rate reported in this study was higher compared with the general population [21]. Besides alcohol, a significant proportion of this population of students reported the use of other substances such as nicotine, tramadol, cannabis, and codeine. Of recent, tramadol appears to be an emerging substance in Nigeria and other African countries, often used in association with other substances [22],[36],[37].
The finding from this study [Table 2] showed that students aged 21 years and above significantly presented with a history of either lifetime (p < 0.001) or current (p < 0.001) substance use. These findings substantiate the fact that substance use and misuse is a developmental health issue with some starting during adolescence period and some in early adulthood [6],[13]. The significantly higher rate or risk of substance use among students in the higher classes also substantiates the developmental nature of substance initiation. This finding also emphasizes the need for the continuous preventive program across lifespan, more importantly in the adolescence and early adulthood. Although several factors influence the use of substances among young adults, the perceived ease of availability, perceptions of a low risk of harm, peer victimization, peer pressure, and other social and economic circumstances may be major factors [17],[20],[24]. As also noted in this study [Table 2], students who were not satisfied with their finances reported a significantly elevated history of both lifetime (p < 0.01) and current (p < 0.05) use of substances. This may be due to the financial strain exerted by the use of various substances on these individuals.
]As expected, male students [Table 2] significantly reported higher risk or rate of lifetime (p < 0.05) and current (p < 0.05) substance use. Earlier studies had reported a higher rate of substance use among males compared with females, even in the general population [6],[13],[19],[21]. Nonetheless, quite an appreciable number of females reported a history of both lifetime and current substance use. The rate of females presenting with substance use is on the increase [38]. This may be due to the deterioration of cultural values, and a move towards the “Westernization” of our society. Again, students in the humanities/social sciences were significantly more to have higher rates of current substance use than their contemporaries in the sciences (p < 0.05). The nature of their courses, the likelihood of having more leisure time and relatively increase odds of experiencing low self-esteem may explain this observation.
Although the majority reported high to normal self-esteem, quite an appreciable number reported low self-esteem, nonetheless, this was not associated with substance use in this population. Earlier studies have reported an association between low self-esteem and substance use [29],[30],[39]. This suggests many factors mediate the initiation and continuation of substance use besides self-esteem. Those current substance users who were 20 years and below were found significantly more likely to have lower mean RSES score compared with their counterparts who are older. This finding confirms previous studies that show as one matures, self-esteem improves [27],[28]. The relatively lower self-esteem in younger ones may also explain why adolescents and younger adults were more likely to be at risk of substance use. Nevertheless, none of these variables, as well as drug use variables significantly predicted low self-esteem, although, students with a history of current alcohol use, lifetime substance use or studying humanities or social sciences courses had a higher risk of experiencing low self-esteem compared with others [Table 3].
Study limitations
The readers are warned not to over-interpret the study findings because this study has the three limitations:
- This is cross-sectional design of the study make it difficult to assume causality.
- This study was conducted in a single university in Nigeria which may not be a national representatives of students as majority of the students are from south-western part of the country where the university is located, however, the proportion of students with substance use is similar to national data.
- The students were essentially from the sciences and humanities; this may not be a representation of other faculties such as medicine which were not included in the study.
Summary
The pattern of substance use in this population is similar to the general population with alcohol representing the most common substance of abuse, although at a slightly higher rate than in the general population. Tramadol, codeine, appears to be an emerging substance of abuse in Nigeria that is often used in association with other substances at a rate now ahead of cannabis. Public health education should also incorporate the danger poses by these substances. Students who abuse substances tend to present with financial difficulties and are more likely to be male, in higher classes, older than 21 years, and pursuing humanities/social sciences. Substance use and misuse is a developmental problem and every effort at preventing substance misuse should be geared towards addressing the problems of substance use not just among adolescents but also among students in their earlier years in the university. Although an appreciable number of participants reported low self-esteem, self-esteem was not significantly associated with substance use in this population; however, low self-esteem increases the risk of having a history of lifetime substance use, and current alcohol use.
| Financial Support and Sponsorship | | |
None.
| Conflicts of Interest | | |
The authors declare no potential conflicts of interest in writing this article.
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[Table 1], [Table 2], [Table 3]
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