Illicit Drug Use among Adolescents: A Public Perception of Inuencing Factors in Owerri, Nigeria

Background: Illicit drug use among adolescents has become a public health concern which cuts across all social strata. This study explored the public perception of factors that inuence illicit drug use among adolescents in Owerri, Nigeria. Methods: A descriptive cross-sectional research design was used for the study. The study adopted a mixed-method approach comprising quantitative and qualitative methods and was carried out in Owerri metropolis of Imo State, Nigeria. The research instruments used for data collection were questionnaires and in-depth interview guide. The target population comprised adults 18 years and above residing in the area of interest at the time of the study. For the qualitative method, a total of 10 communities were selected randomly by balloting and availability sampling was employed in the selection of respondents. Respondents for the qualitative method were purposively selected. Results: Our quantitative study found that 50.7% of the respondents, from across the three areas in Owerri metropolis, asserted that peer inuence, emotional problems, relationship problems, wanting to feel ‘high’ are factors inuencing adolescent consumption of illicit drugs whereas the qualitative study found family background, unique experience such as the death of a loved one, aiction or misfortune as factors inuencing adolescents’ illicit drug use. The quantitative results showed that persons with a higher level of education are more likely than those with a lower level of education to perceive a signicant difference in drug use between in – school and out – of – school adolescents. Conclusions: Peer inuence, emotional problems, relationship problems and the inuence of media (especially the social media), among several other identied reasons, are perceived by the public as factors that inuence adolescents’ use of illicit drugs. As a means to curb some of these factors, the communities, schools and universities should formulate contextual policies to prevent drug use and should also hold seminars for parents and families to alert them early to the symptoms of drug use in their children.

A study by Ibebuike (26) sought to determine the rate of substance used, and adverse effects amongst senior secondary school students of Eziachi, Orlu, Imo state. The study found that the majority of them used substances due to peer pressure, while for others it is due to academic adjustment, social and psychological factors. The most common reasons given for substance use was to have a feeling of belonging, followed by "to increase morale" and to have pleasure, to be awake because it is cheap and is always available. Other systems currently available to gauge drug use levels and trends, such as the national household survey of drug use estimating the drug use in the total population have not been performed in Imo State till date (27).
Recently, researchers have started paying attention to the issue of illicit drug use in Nigeria (14,15,23,28). However, most of these studies ignored the public perception of illicit drug use among youths. Considering that the public has an important role to play in an attempt to reduce the rate of illicit drug use, how they perceive illicit drug use among youths must be ascertained. Moreover, how the public perceives an issue may reveal the level of attention it gets and the best strategies of addressing it. Because perception is shaped by things such as previous experience, cultural expectations, motivations, moods, needs and attitudes (29,30), ignoring it on issues that require modifying public policy or public behaviour, may lead to the failure of technically good innovations. It is against this backdrop that this study focuses on exploring the public perception of factors in uencing illicit drug use among adolescents in Owerri metropolis.

Research Objective
To ascertain the factors that in uence adolescent drug use from the perspective of the public.
Research Questions 1. 1. What are the factors that in uence illicit drug use among adolescents? 2. Would adolescents still consume illicit drugs if they knew the possible consequences?
3. Is there a difference in drug use between in-school adolescents and out-of-school adolescents? Hypotheses 1. There is no signi cant difference in the proportion of males and females who will perceive that adolescents would consume illicit drugs even if they knew the possible consequences.
2. There is a signi cant difference in the educational level of respondents who will perceive a signi cant difference in drug use between in -school and out -of -school adolescents.
Theoretical framework Social Learning Theory (by Albert Bandura in 1977) was adopted for this study. Social Learning Theory holds that behaviour is in uenced by environmental factors, not just psychological or cognitive factors. Thus, Social Learning Theory assumes that behavioural, psychological and environmental factors combined, in uence the development of speci c behaviours. In other words, what people are exposed to or observe could make all the difference in their lives.
Using this theory, this study ascertained the extent to which a person's behavioural intentions can be affected by what he/she expects to experience and how much these expectations stand to cover the person's ability to see its damaging effects. The theory is also relevant in exploring the role of the public (as an aspect of the environmental factor) towards these expectations and possible outcome i.e. what the public is exposed to (in terms of knowledge on adolescent drug us). Sex and educational level are characteristics that could affect the public's perception of the subject matter.

Study design and study area
A descriptive cross-sectional research design was used for the study. The study adopted a mixed-method approach comprising quantitative and qualitative methods. The area of study was Imo state, and there are 27 local government areas in Imo state. However, only three that makeup Owerri metropolis were used for the study. The three local government areas that makeup Owerri metropolis include Owerri West, Owerri North and Owerri Municipal. The choice of this study area arose from the fact that there are undocumented reports of illicit drug use among young people in the region.

Study population and selection of study participants
The study population consisted of members of the public aged 18 years and above, residing in Owerri metropolis at the time of the study. To ensure that Owerri metropolis' urban and rural communities and their respondents were truly represented in the population, a cluster sampling procedure was adopted. The justi cation for this is because Owerri metropolis has a considerable landmass and it will be di cult and expensive to cover such a vast area. The communities that comprise each local government was represented with numbers and these numbers written on individual pieces of paper folded and shu ed (selection by balloting). They were selected one after the other randomly until the desired gure was reached. A total of 10 communities were selected randomly in all. Simple random sampling technique of balloting without replacement was used to determine which communities get picked from the LGAs. Using Taro Yamane formula for determining the nite population and the sample size derived for the study was 624. In the four communities that were selected from Owerri West, 200 respondents were randomly selected. In the ve communities that were selected from Owerri North, 220 respondents were randomly selected. In the one community that was selected from Owerri Municipal, 204 respondents were randomly selected. Information was collected from students living in off-campus hostels, people in o ces, markets and people found on the street all of whom meet the age category for the study. The lead author trained 2 researchers who participated in data collection.

Instruments of data collection
The research instruments used for data collection were questionnaires and in-depth interview guide. The questionnaire contained semi-structured questions. The questionnaire was developed based on the objective of the study. The questionnaire elicited information on the respondents' perception of factors in uencing adolescents' involvement in illicit drug use, and consequences of these factors as well as strategies to curb illicit drug use among adolescents. The questionnaires were distributed to respondents in their homes, on the street at their places of employment. The distribution was based on the availability of the respondents and they must meet the study criteria to.
The interview guide contained structured questions on adolescent drug use, factors in uencing their involvement as well as strategies to curb them. A total of 16 respondents were purposively selected for key Informant interviews (KIIs) which were in-depth in nature. Three respondents from a Psychiatric unit at Owerri (a representative of the o ce of the director [RepOD], a doctor and a nurse), by virtue of their profession as medical and health personnel, the researchers believe that they would be well informed of the issue under investigation. A representative of the social welfare, at Owerri [RepSW], was also selected because it was believed that he would possess knowledge about deviant behaviours of young people in the metropolis. These 4 respondents were interviewed in their respective o ces. Also, twelve other respondents (four from each LGA) comprising of an elder statesman and woman, youth leaders and other in uential community leaders were selected for the in-depth interview. Among these 12 KII respondents, 9 were interviewed at their homes while 3 were interviewed in a bar of their choosing. The rationale for their selection was based on the assumption that they are knowledgeable about the subject matter and how it plays out in their respective communities.

Validity and reliability test of the instrument
The face validation of the instrument was determined by subjecting the instrument to the scrutiny of experts in the eld of Sociology from the Sociology/Anthropology of the University of Nigeria, Nsukka. The experts were allowed a free hand. The modi cations and suggestions made by the experts were incorporated to produce the nal copy of the instruments. A pilot study was conducted with 62 (10% of the study sample size) respondents chosen randomly from Okigwe LGA. This area has similar characteristics to the study area in terms of population and structure. The responses were coded and put into the computer using SPSS v21.

Data analysis
The data from questionnaires were collated and coded manually and entries put into the computer. The data were analyzed with the Statistical Package for Social Sciences (SPSS version 21). The analysis employed descriptive statistics such as frequencies and percentages to present the characteristics of the research subjects. Chi-Square (χ 2 ) (goodness of t and test of independence) was used to ascertain the differences among male and female respondents regarding their perception on whether adolescents would consume illicit drugs if they knew the possible consequences and whether there is a signi cant difference in the educational level of respondents who will perceive a signi cant difference in drug use between in -school and out -of -school adolescents. The hypothesis will also, offer further explanation to objectives 2 and 3. In analyzing the qualitative data, the researcher began with a careful transcription of the data. The transcripts derived from the in-depth interviews were read and coded with the Nvivo 11 software according to emerging themes. Thematic methods were used in the analysis of the qualitative data. The emerging themes were further grouped into major recurring themes and then analyzed accordingly. Salient illustrative quotes were then pulled out to complement and elucidate the quantitative data in reporting the results.

Results
Out of the total of 624 questionnaires that were distributed in the course of the study, 535 questionnaires were properly lled and returned -showing a response rate of 85.7%. Speci cally, 209 questionnaires were returned from respondents in Owerri North, 221 and 105 questionnaires in Owerri West and Municipal respectively.
Socio-Demographic data of the Respondents Table 1 highlights the distribution of respondents according to their sex, age, educational attainment, marital status and occupation. Factors in uencing adolescents' involvement in illicit drug use The information in Table 2 shows a multi-choice response of factors that respondents believe in uence adolescents' use of illicit drugs. Majority of the respondents (92.9%) chose peer in uence. Other factors chosen are to feel 'high' (70.5%) and Emotional problems (67.8%), amongst others. Respondents views were sought on whether or not adolescents would consume illicit drugs (e.g., cocaine, weed, etc) if they knew the possible consequences. According to the data in Table 3, over half (58.3%) of the entire respondents disagreed that adolescents would consume illicit drugs (e.g., cocaine, weed, etc) if they knew the possible consequences; 34.6% agreed, while 7.1% indicated that they did not know the likely outcome. Source: Survey (2018) for Illicit Drug paper The information in Table 4 shows the sex-disaggregated distribution of respondents on reasons adolescents would consume illicit drugs (e.g., cocaine, weed, etc.) if they knew their possible consequences. The result shows that 42.2% of the entire study respondents believed that because it is di cult to change addictive behaviour, adolescents would continue to use illicit drugs even if they knew about the possible consequences. Respondents were asked to state whether there is a difference in drug use between adolescents who are in school and those who are not. In line with this, table 5 shows that 51.4% stated that there is a difference in drug use between inschool and out-of-school adolescents. On the contrary, 37.4% of the respondents said there is no difference. However, 11.2% of the respondents did not know whether a difference exists. Hypotheses testing Hypothesis 1: There is a signi cant difference in the proportion of males and females who will perceive that adolescents would consume illicit drugs even if they knew the possible consequences.
This hypothesis was tested using analyzed data in Tables 1 and 3. To test this hypothesis, a chi-square (X 2 ) test of independence and the statistical package (SPSS 21.0) were employed.  Table 6, it could be observed that of all the respondents who said that adolescents would consume illicit drugs even if they knew the possible consequences, the majority were males (60.5%) and the remaining 39.5% were females. On the other hand, more than half of the respondents who disagreed with this statement were females while the remaining 42.3% were males. This output suggests that there were more female than male respondents who did not think that adolescents would consume illicit drugs if they knew the possible consequences.
A further observation of the chi-square output shows a statistically signi cant difference in the proportion of male and female respondents regarding their perception of whether adolescents would still consume illicit drugs even if they knew the consequences (X 2 = 15.5; df = 1, N=497, P<.001).
Hypothesis 2: There is a signi cant difference in the educational level of respondents who will perceive a signi cant difference in drug use between in -school and out -of -school adolescents.
The hypothesis was tested using analyzed data in Tables 1 and 5. The data in Table 1 were re-categorized with no formal education, primary school and secondary school being classi ed as belonging to a lower educational level (246 in all) and respondents in the other categories as those with a higher level of education (289 in all). Here, only 475 respondents' information was used for testing the hypothesis. To test this hypothesis, a chi-square (X 2 ) test of independence and the statistical package (SPSS 21.0) were employed. This response is re ected in Table 7.  Table 7, it could be observed that of all the study respondents who perceived a difference between adolescents who are in school and those who are not as regards their drug use, a greater majority (71.4%) were in the category of those with higher educational level, while the remaining 28.6% were in the category of those with lower educational level. On the other hand, majority of the respondents (56.5%) who perceived that there is no difference between adolescents who are in school and those who are not as regards their drug use were in the category of those with higher educational level, while the remaining 43.5% were in the category of those with lower educational level. Overall, more respondents with a higher level of education than those with a lower level of education perceived a difference between adolescents who are in school and those who are not as regards their drug use. A further observation of the chi-square output shows a statistically signi cant difference in the proportion of respondents with a higher level of education and those with a lower level perceived a difference between adolescents who are in school and those who are not as regards their drug use (X 2 = 36.9; df = 1, N=497, P<.001).

Reasons adolescents use illicit drugs
For the qualitative ndings, reacting to this, respondents mentioned such factors as peer pressure, family background, emotional problems, major life events or unique experience (death of a loved one, a iction or misfortune), youthful exuberance, the need to feel 'high', mass media, personality factors, among others. Respondents were also asked to discuss how these factors impact on adolescents' choice of illicit drug use and behaviour. One of the respondents who described how emotional problems impact adolescents' choice of illicit drug use and behaviour had this to say: "… someone may feel that the economic realities are so harsh and thus insolvent and may experience depression. Depending on his/her ability to cope with the situation, such a person may take to illicit drugs as a temporary measure to forget about his/her environment" (RepOD).
Another respondent who spoke extensively on how major life events or unique experience (death of a loved one, a iction or misfortune) can in uence adolescents' illicit drug use opined that "…some experience can cause a dramatic change in a persons' life to an extent that taking to drugs become the only escape route. For instance, a rape or incest victim may constantly take to drugs whenever she thinks of the horri c experience she had": Will adolescents use drugs if they knew the possible consequences?
Majority respondents averred that the knowledge of the consequences of drug intake cannot necessarily decrease its usage. To them, the instant grati cation and the euphoria that come with drug use may encourage adolescents to rationalize illicit drug use. One of the respondents puts it this way: "Because adolescents perceive issues relating to the implications of illicit drugs on human lives as an abstract subject, they tend to justify the existence of drugs. Some of the adolescents go as far as arguing that illicit drug use is as old as man and because a pocket of people dies due to drug use, does not mean that it will kill everyone. One of the younger folks I counselled at a time, told me that drug kills people who are not smart at taking it. The implication is this: it is either the usage increases or stays the same way" (Nurse).
Other respondents who perceived that the knowledge of the consequences of illicit drugs can in uence adolescents to decrease their drug intake expressed the view that adolescents may nd it very di cult to stop; however, they can decide to stop or reduce the intake if they are faced with pernicious situations. Bolstering this position, one of the respondents averred that: "the crisis that comes with addiction and the whole withdrawal symptoms thing can make the knowledge of the consequences of illicit drugs meaningless" (Youth leader, male).

Discussion
The study examined the perception of the public on factors in uencing illicit drug use among adolescents. Knowing the perception of the public would help inform future steps that might be taken towards ameliorating this public health concern. From the ndings, majority of the respondents considered peer in uence as a leading factor in uencing illicit drug use. . Other factors are the desire to feel 'high', emotional problems, relationship problems and to cope with their academic problems or assimilate better, what they read. They also indicated that some of these adolescents use illicit drugs to help them cope with challenges such as harsh economic realities or the death of a loved one which could create a vacuum in their heart or traumatizing circumstances like rape. The respondents believe that when these adolescents use these drugs, it would temporarily put their mind at ease. The same thing goes for relationship problems. However for the peer in uence factor, that was frequently mentioned, underscores the in uence of such a group on deviant behaviours. One of the reasons why peer in uence has been perceived as an important factor during the stage of adolescence is perhaps due to its crucial role as an agent of socialization. Although the peer group was previously regarded as second only to the parents in socializing the child, the peer group currently equals the family in terms of in uence over adolescents (31). This according to this study, the increasing in uence of peer group on adolescent behaviour could be because "adults and parents would not discuss certain sensitive issues, which the adolescents are curious about; adolescents are left to deal with these issues on their own. The 'most experienced' in the peer group usually takes the lead, gives advice and plays a parental role to other adolescents who are in desperate need of acceptance". Now that we have known the factors that in uence adolescent drug use as perceived by the public. It becomes imperative to know if they (public) think that availing them (adolescents) with information on the possible consequences of illicit drug use will curb their use of such drugs. However, more than half of the respondents (58.3%) don't think that the knowledge of the possible consequences will necessarily stop the use of these drugs. Some of the reasons they have this perception are because, rstly, the instant grati cation and euphoria that come with drug use might encourage adolescents to rationalize drug use. From their point of view, these adolescents believe that the fact drug use kills some persons does not mean it will kill everyone, in other words, consequences are over-exaggerated.
Secondly, there is the issue of addiction. Changing the continual behaviour of drug use is di cult and if drug use becomes an addiction for these adolescents, knowledge of the consequences, later on, wouldn't change anything in terms of usage. Other reasons are that the present feeling of pain, emptiness, trauma etc. cannot be compared to any later consequences and the peer group in uence with social comparison i.e. adolescents taking up drug use in other to feel belonged or accepted among their peers. However, more than half of the respondent believe that knowledge of the possible consequences can hinder these adolescents from using these drugs. The hypothesis tested shows that male respondents are more likely than female respondents to perceive that adolescents would consume illicit drugs even if they knew the possible consequences. While planning interventions or programme for adolescents who use drugs, there should be an equal representation of both males and females as uniform representation will go a long way to guarantee and e cient programme development. Most of the strategic positions in our society (especially in communities) are headed by men and if information comes from mostly them, it could be misleading.
Furthermore, the study attempted to identify the categories of adolescents i.e. in -school (adolescents enrolled in a school) or out -of -school (adolescents not o cially enrolled in any school) that are perceived (by the public) to be more involved in the use of drugs in Owerri metropolis. There is no signi cant difference in drug use between the two categories, however, the hypotheses tested in this regard shows that those with a higher level of education are more than likely to perceive a difference. While it is possible that the public believes that it does not matter the categories of adolescents (whether in or out-of-school, rural or urban area, male or female, etc.) when it comes to illicit drugs use, both categories are almost same, it also goes to show that respondents' level of education can and does in uence their perception on the subject matter.
Finally, the study has helped to validate the social learning theory. According to the theory, behaviour is in uenced by environmental factors, not just psychological or cognitive factors. In the current study, we have found that peer in uence, emotional problems, relationship problems, media, youthful exuberance, wanting to feel 'high' and other reasons are perceived factors that in uence adolescents' use of illicit drugs. All of these factors represent either or all of the concepts developed in the social learning theory. For instance, while peer pressure could be representative of the environmental factors, emotional problems or youthful exuberance, and wanting to feel 'high' could be representative of the behavioural factors, psychological factors and how/what they expect to feel, respectively. We cannot talk about environmental factors without talking about the public and their perception of things. To address the increasing rate of illicit drug use, the public has a crucial role to play. Their perception of illicit drug use among adolescents must be ascertained. Understanding how the public perceives an issue may reveal the level of attention such an issue gets. To create and implement an e cient policy that will go a long way to address this public health issue, public perception is crucial. Ignoring public perception on issues that require modifying public policy or public behaviour, might result in the failure of technically good innovations (33). This theory can also serve as resource tools in the development of intervention strategies in tackling drug problems, especially among adolescents.

Study Limitations
The study only focused on the public's perception of factors that in uence the drug use of adolescents. It, however, did not discuss the public's perception of the consequences or the strategies to curbing this behaviour.

Conclusion And Recommendation
Peer in uence, emotional problems, relationship problems, the in uence of media (especially the social media), youthful exuberance, wanting to feel 'high' among several other identi ed reasons are perceived by the public as factors that in uence adolescents' use of illicit drugs. More particularly, peer pressure was perceived by a majority of the respondents as a major factor and it was also identi ed as rivalling the family in terms of in uence.
To develop policies that will be more e cient in tackling the issue of drug use among adolescents, the understanding of the public on the subject matter needs to be ascertained. Therefore, through the public: A social environment should be created which would discourage drug use, with the community, schools and universities, educating children at a very early age (primary school level on the dangers of drug use and the value of life.
Finally, the communities, schools and universities should formulate policies to prevent drug use and should also hold seminars for parents and families to alert them early to the symptoms of drug use in their children.

Declarations
Ethic Approval and consent to participate The study was approved by the ethics committee of the department of Sociology/Anthropology, University of Nigeria, Nsukka. Each participant was given a consent form to sign showing their consent to participate in the study.