Prevalence and risk factors of substance use among urban adolescents: questionnaire study.

AIM To examine the prevalence and possible interconnections among the frequencies of consuming various psychoactive substances in Zagreb adolescents. Also, to assess risk factors associated with the use of tobacco, alcohol, and marijuana. METHOD We applied an anonymous, multi-dimensional, self-reporting questionnaire on a representative sample of 2,404 elementary and high school students (total age range, 13-23 years) from Zagreb, Croatia. The questionnaire was designed to explore the extent to which examinees consumed various psychoactive substances, as well as to assess their attitudes and knowledge about the substances. The socio-demographic data were collected on all examinees, their hierarchy of values, family relations, adjustment to school, relationships with peers, and high-risk and delinquent behavior. We analyzed the interconnections among the frequencies of consuming various psychoactive substances, and assessed the factors possibly predictive of substance use. RESULTS Almost 90% of all examinees experimented with alcohol at least once, 80% with tobacco, 39% with marijuana, and 9% with Ecstasy. Thirty-six percent consumed alcohol and 11% marijuana several times a month, whereas 28% smoked tobacco daily. Although there was no statistically significant difference according to sex in experimenting with psychoactive substances, day-to-day abuse was significantly more frequent among young men than women. About 43% of our examinees believed consuming marijuana should become legally permitted, 37% were against this policy, and 21% were undecided on this issue. Our results showed a high degree of interconnection among the frequencies of consuming tobacco, alcohol, and marijuana. We also found that the best predictive factors for consumption of these three substances were a history of high-risk and delinquent behavior, troubled adjustment to school, domination of hedonistic values, and poor family relations. Regression analysis and pondering for ratios of particular predictors of psychoactive substances use gave values for coefficients of multiple regression as follows: R=0.548 (R(2)=0.300; p<0.001) for tobacco, R=0.575 (R(2)=0.330; p<0.001) for alcohol, and R=0.608 (R(2)=0.370; p<0.001) for marijuana. Knowledge about the consequences of consuming psychoactive substances positively correlated with the frequency of consuming tobacco (r=0.213, p<0.001), alcohol (r=0.226, p<0.001), and marijuana (r=0.320, p<0.001). CONCLUSION Most adolescents had personal experience with psychoactive substance abuse, mostly alcohol, tobacco, and marijuana, but only a smaller proportion became regular consumers. The frequency of substance consumption implied a generalized tendency towards substance abuse among Zagreb adolescents. Our findings could serve as empirical basis for the re-evaluation of the current drug prevention programs and programs aimed at preventing other forms of risk behavior among children and adolescents.