Substance use and associated factors and associated factors among preparatory school students in Nekemte town western Ethiopia; school based a cross- sectional study

Background: Millions of people throughout the world are using substances such as alcohol, nicotine, cocaine, methamphetamine, morphine, marijuana, heroin and many others. Substance use by people in all parts of the world, particularly adolescents, has long been of scientific, political and public concern. Objective: the main aim of this study was to prevalence of substance use & associated factors among Nekemte preparatory school students in 2019. Methodology:- . School based cross-sectional study was conducted among students at Nekemte preparatory school from March 20-30, 2018. Multistage stratified sampling method was employed to select 372 study participants. Collected data was cleaned and entered in to Epi info version 3.5.3 and transported to SPSS (statistical package for social sciences) version 20 for analysis. Descriptive statistics and logistic regression was done to indentify factors associated with substance use in the study area. Result: The overall prevalence of current substance use was (19.1%). Being male students [AOR, 95%CI; 4.64(2.18, 9.75)], ever encountered pressure from friends to use substances [AOR, 95% CI; 2.61(1.03, 6.63)], having substance user parents [AOR, 95%CI; 6.4(2.87, 14.30)] and having many substance user friends [AOR, 95%CI; 6.2(2.82, 13.75)] were significantly associated with substance use among students in the study area. C onclusion & Recommendation : The current prevalence of substance use among preparatory school students of this study area was low. The most commonly used substances were alcohol, khat and tobacco. Being male students, pear pressure, living with parents use substance & friends were found to affect substance use among Nekemte preparatory school students. Awareness creation sessions; Information, Education &Communication intervention should be

3 intensified to further reduce Substance use among students.

Background
The World Health Organization (WHO) estimates that about 30% of the adult male global population smokes. National smoking prevalence among men in sub-Sahara Africa varies from 20% to 60%. Smoking is estimated to cause about 71% of lung cancer, 42% of chronic respiratory disease,10% of cardiovascular diseases and stroke(1).
In 2012, about 3.3 million deaths or 5.9% of all global deaths were attributable to alcohol consumption, 139 million DALYs (disability adjusted life years) or 5.1% of the global burden of disease and injury were attributable to alcohol consumption (2).
Burden of impairment attributable to alcohol and tobacco are 5.4 and3.7%; cause for death of 2.5 and 6 million people each year respectively. chat and alcohol use is linked to unprotected sex, putting young people at risk of unwanted pregnancy, abortion and HIV/ ADIS infection (3).
substance use is common among adolescent or young people the world wide and almost all secondary school student are the domain of this age (4). Because, students or this age group population has low perceived risk for substance use, family and friends who use substance, community laws and norms favorable to drug use and poverty (5). Not only this abut also multiple interacting factors influence substance use like :availability, social acceptability, and peer pressures, particular actions of the substance, personality and individual biology (6).Similarly, age, sex, unemployment, low education levels, poor health, low income families, lack of family support and conflict in the family can be factors lead individual to use substance (7).

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Despite this substance abuse is being taken as assign of modernity or civilization among secondary school or young population. This period is the beginning of time when young people start influenced by peers and get independent from family control. Therefore the aim this study is to determine prevalence of substance abuse and contributing factors among preparatory school students in Nekemte town.

Sampling procedure
Multistage stratified sampling technique was employed to select across different sections. First the students were stratified based on their grade (grade 11 th and grade 12 th ). The proportion to size sample was assigned to both grades (11 th and 12 th ). Then 20% of the sections were considered from each grade and 8 sections and 4 sections from 11 th and 12 th grade were selected. Again sample was assigned to each selected section of each grade (11 th and 12 th ) and systematic sampling method was employed using different sampling fraction to select individual respondents.

Data collection and tools
Instrument/tool: Data was collected using self-administered structured questionnaire was used to collect information on socio demographic data and other important data related to objectives of the study. The tool was adopted from The European School Survey Project on Alcohol and Other Drugs (8) and modified based on the scope this study which was prepared first in English and translated to Afaan Oromo and translated back to English by other individual to check consistency of the tool. Data collection facilitators were experienced individuals but not instructors in the same school and training was given by the principal investigators specially how to create conducive environment for the respondents during data collection, and how to give clarity, if there is any inconvenience. Following an orientation, questionnaire was distributed for selected student based on sampling fraction and filled in private

Data quality management
Structured questionnaire was adopted and modified according to the variables included in the study and pre-test was conducted to see, if there is ambiguous question and appropriate corrections were given before the actual data collection.
Data collectors were trained and strict supervision were there during data 6 collection. Data was double entered to check the consistency Data processing and analysis Data were coded, entered into Epi info version 3.5.3 and exported to SPSS version 20.0 for analysis. Descriptive statistics were computed to determine the frequency and percentages. Binary logistic regression was conducted and COR, with 95% CI was estimated to select the candidate variables for the final model. Then, variables with a p-value of < 0.3 were candidate variable for multivariable logistic regression.. Hosmer-Lemeshow goodness-of-fit with stepwise (backward elimination) logistic regression was used to test for model fitness. AOR with 95% CI was estimated to assess the presence of association at multivariable logistic regression.
Finally, variables with a p-value of <0.05 were considered as statistically significant predictors of the outcome variable.

Operational definition
Substance: For this study it was defined as alcohol, khat, cigarettes and illicit drugs to alter their mood or behavior.
Substance abuse: For this study it was defined as the abuse of alcohol, khat, cigarettes and illicit substances by students.
Current use: having consumed or used substance at least once in the past 30 days.
Ever use: an individual is considered as ever use if he/she consume at least once in his/her lifetime.

Ethical clearance
Ethical clearance was obtained from the Research and Ethics Committee of Wollega University. An official letter was written to each hospital to get official permission.
Participants were informed that privacy and confidentiality will be maintained on the information sheet and written consent form. Written consent was taken from 7 study participants.

Discussion
Prevalence of substance use among students in this study area was 19.1%. This finding was lower than study done among high school adolescents in Woreta Town, Northwest Ethiopia of which current 47.9% (5). The difference might be due to difference in study period when information, education and legislation is being intensified to reduce substance use. Reasons mentioned by respondent to use substance were: to socialize 18(36%) and for entertainment 18(51.4%) whereas the most basic motivation for substance use in this area was peer pressure 55(49.5%).

This finding was in line with Study done in Debere Birhan university students and
Haramaya University students where the reasons for substance use were enjoyment, to stay awake peer pressure, to socialize and to improve academic performance (2,9,10) In this study area, the most commonly used substance were alcohol 50 (13.4%), khat 35(9.4%) & tobacco29 (7.8%). This is also lower than finding in Dire Dawa secondary school and Ginnir town preparatory school , Bale zone (11,12). This difference may be due to difference in stud area where there is availability of chat and otter substance. On the other hand most of the populations in these two areas (Dire Dawa & Ginnir town, Bale Zone) are Muslim in religion and some research reveal that being Muslim is strongly associated with chewing chat and other substance (13).
The result of multivariate logistic regression revealed that, there were factors associated with substance use among Nekemte preparatory school student. Being male sex was strongly associated with substance use in this study area which is in line with study conducted in Addis Ababa University and Haramaya university health and medical students and jigjiga university students(9,10, 14,). Other finding from systemic review of alcohol consumption in Ethiopia support this finding that, the prevalence of hazardous alcohol consumption was remarkably higher in men than in women (15). Level of education attained or grade of students were found to influence substance use among our respondents where students of 12 th grade were more likely to use substance than their counterparts. In Jigjiga university the odds of drinking alcohol was higher among senior students; those at 3rd year those at 4th year; compared with their junior 2nd year students (9,14) In our study having many friends using substance were found to affect substance use among preparatory students. In Addis Ababa substance use was high among those students whose friends were drinking alcohol (13)

also in Debra Berhan
University the study revealed, having substance user families and friends were found to be variables significantly associated with students' substance use behaviors (2).
Having family or parents using substance was another predictor of substance use among students of our study area which is similar to study conducted in Debra Berhan University students, Haramaya University health and medical science students where students from substance user families were more likely to use substance and in Debra Markos poly technique college history of family drug use was highly associated with students substance use (7, 11, 12,). In this study peer pressure was strongly associated with substance use among students in our study area. In Debra Markos poly technique college students who had experienced peer pressure was more likely to use substance than their counterparts (6).
The study has different limitation First; the study used a descriptive single crosssectional design that cannot establish trends and causality between substance use and risk factors. Second, the data was collected using self administered questionnaire which may be subjected to recall bias and under-reporting of substance use due to social desirability bias. Finally, the types substance reported in this study were cigarette, alcohol and kchat only. Despite the limitations, our finding has substance finding which encourage the family, community, teachers and other stakeholders to give attention for substance use among students.

Conclusion and recommendation
The prevalence of substance use in this study was low. The most commonly used substances were alcohol, khat and tobacco where the main reasons mentioned by respondents to use substance were: to socialize, for entertainment whereas the most basic motivation for substance use in this area was peer pressure. Being male students, pear pressure, living with parents use substance & friends were found to affect substance use among Nekemte preparatory school students. Awareness creation sessions; Information, Education &Communication intervention should be 11 intensified to further reduce Substance use among students. Further research should be conducted to explore for other factors associated with substance use not only for the three substance mentioned but also other substances in other setting other than preparatory school.

Ethical consideration
Ethical clearance was obtained from Wollega University, School of Public Health Ethical Review committee. Permission for conducting the study was secured from the Nekemte Town Health bureau. Written consent was obtained from all the study participants after they had briefed about the objectives and the aim of the research. Confidentiality of the information gathered was assured to the interviewee.  Figure 1 Reason for ever use of substance among Nekemte preparatory school students, march, 2018