Substance Abuse among Students in a Dental School

ABSTRACT Introduction Substance abuse has become a burning issue among the medical and dental students. Dental students, who later transform into dentists, have a significant role in substance abuse cessation. Thus the study was undertaken to quantify substance abuse among dental students of Kantipur Dental College. Methods A descriptive cross-sectional study was conducted using pretested self-administered questionnaire among undergraduate and post graduate students of Kantipur Dental College. Convenience sampling was done and sample size was calculated. Results Study revealed 166 (74.10%) as never smokers, 3 (1.30%) as former smokers and 55 (24.60%) as current smokers. Similarly 97 (43.3%) students never used alcoholic drink, 95 (42.41%) consumed alcohol monthly, 29 (12.95%) consumed alcohol 2–4 times a month and 3 (1.34%) consumed alcohol 2–3 times a week. A total of 78 (35%) students used cannabis. Conclusions Substantial numbers of students were indulged in deleterious habits of smoking, tobacco and cannabis intake. Students need to be properly counselled to discourage substance abuse and create a healthy society.


INTRODUCTION
Substance abuse is a burning issue in this modernized era. Medical students are indulged in abuse of stimulants (e.g. Cocaine), sedatives (e.g. Lorazepam), hallucinogens, e.g. Lysergic acid diethylamide (LSD), opioids, cannabis, alcohol and tobacco. 1,2 Report of Global Health Professional Survey Nepal-2006 shows, approximately 40 to 64% of students who participated in the survey had used tobacco during their life time, and about 17.4% to 23.7% were current smokers. A good proportion of students (58.0% dental and 43.5% medical) also reported nicotine dependency. 3 Substance abuse is not only responsible for declined physical 4 and mental fitness 5 of an individual but it also increases the disability adjusted life in years (DALY) on long term. 6 Dentists have a significant role in motivating their patients for substance abuse cessation. As the dental students are the one to transform into dentists, they represent a primary target for substance abuse cessation programs.
Thus the study was undertaken to quantify substance abuse among dental students of a Dental College. A total of 250 pretested, self-administered, structured questionnaire were distributed to the students which was collected after being filled. Written consent was taken prior to study and the participation was voluntary. Confidentiality of the participants was ensured. The participants were informed that their participation in the study was completely voluntary and they could withdraw from participation at any time. Study reveals tobacco, alcohol and cannabis as most commonly abused substances. So our study focuses in the abuse of these three substances. Smoking questionnaire contained details on tobacco smoking where the smokers were classified as: i. Never smoker ii. Former smoker iii. Current smoker 7

METHODS
Parental tobacco use was defined as habit of smoking tobacco by either or both parents. 8 Also, use of cannabis was assessed. A modified Alcohol Use Disorder Identification Test (AUDIT) questionnaire was used to assess the magnitude and severity of alcohol abuse. 9 It consisted 10 questions based on three domains which were categorized as hazardous alcohol use (pattern of alcohol consumption that increases the risk of harmful consequences for the users or others), harmful alcohol use (alcohol consumption that results in consequences to physical and mental health) and alcohol dependence (cluster of behavioral cognitive and physiological phenomena that develops after repeated alcohol use). 9 A cut off score of eight was used, above which were suggestive of the indicators of hazardous and harmful alcohol use as well as possible alcohol dependence.
Questionnaires were administered during regular class in a voluntary manner, according to the protocol. The questionnaire was pretested among 25 students in order to ensure that the students could understand and answer the questions without any help. The validity of the questions was established by using standard questionnaire, which has been used in many previous studies across the world. 3,9 Questionnaires were distributed to the participants by a single investigator and they were collected on the same day. Descriptive statistical analysis was performed using the SPSS version 20 software.

RESULTS
Out of 250 questionnaires distributed, only 224 questionnaires could be recollected with an overall response rate of 89.6%, of which 186 (83%) of the respondents were female and 38 (17%) were male. Students who had experienced smoking (even one or two puffs) is shown in (Table 1). Among those who smoked, 8 (8.60%) students first tried smoking at the age of 10-15 years, 47 (50.54%) at the age of 15-20 years and 38 (40.86%) when they were 20 years and above. The smoking habits were categorised as Never smoker, Former smoker and Current smoker which is depicted as below ( Figure 1). Likewise, the cause of smoking is summarized in graph below ( Figure 2).  On the other hand, 127 (56.7%) of the students had the habit of drinking alcohol. Synopsis of frequency of alcohol consumption is summarized below (Figure 3).
Free Full Text Articles are Available at www.jnma.com.np Harmful or hazardous alcohol use as well as incipience of alcohol dependence was found in 27 (12.05%) of total students.

DISCUSSION
The study revealed that, among the total students enrolled 74.1% were non-smokers, 24.6% were current smokers and 1.3% were past smokers. The prevalence of cannabis use was 35% and alcohol based products was 55.8%. This is in agreement with the finding by Khanal et al where alcohol (57.6%) was the most prevalently used substance followed by tobacco (27.58%). 10 Contrary to this, a study carried out among male medical and dental students by Ghimire et al showed that 38.4% students were smokers (46.4% occasional and 53.6% regular smokers) and 61.6% were non-smokers (87.8% never smokers and 12.2% ex-smokers). Nearly one third of the participants used to consume alcohol along with smoking. 3 Additionally, a study on smoking and alcohol intake among medical students in south western region of Nepal revealed that 9% of the students were smokers and 20.33% were alcohol users. 11 Similarly, a survey conducted to assess the alcohol use among physicians in a medical school in Nepal revealed 63% of the physician to be alcohol user. 12 Differences seen in the prevalence of substance abuse may be attributed to the variation in definition and classification adopted for substance use, socio demographic, genetic as well as psychological parameters of the individual enrolled in the study. 13 In current study, majority of the smokers started smoking when they were between 15 to 20 years of age (50.54%) which coincides with the finding of study conducted in BPKIHS and also with the study by Kumar et al which concluded that 62.7% of medical students started smoking between 18 to 20 years of age. 14 Results suggesting the vulnerability of youth towards havoc of substance use advocate sincere efforts in protecting the youths as early as possible. The study depicted that the main cause of smoking among the students of KDC was pleasure (32.3%) followed by peer pressure (28% Since this is a self-administered questionnaire based study, there are chances of reporting and selection bias. Also the results may not be completely reliable as the responses were not validated by biomarkers of substance use. The study is carried out among limited number of students in a single institute; therefore the results cannot be generalized.

CONCLUSIONS
The study reveals a substantial proportion of students Free Full Text Articles are Available at www.jnma.com.np indulged in substance abuse. Majority of the students used substance for sake of pleasure followed by irresistible peer pressure. Substance abuse by dental students has direct effect on their health as well as health of many people because they serve as a role model for their patients and communities. Therefore these students need to be properly guided and counselled in order to discourage such activities and create a substance free healthy society.