Prevalence and associated factors of substance use among regular students in Debre Tabor University, Amhara region, Ethiopia in 2019

Background: Substance abuse is inappropriate use of drugs or psychoactive substances in which the user consumes the substance with amount or methods which are harmful to them or others. Prevalence and associated factors of substance use among regular students in Debre Tabor University, Ethiopia 2019G.C Methods: Institutional based cross-sectional study was conducted using structured pretest and self-administered questionnaires. Systematic random sampling technique was used to collect data within sample size of 308. Result. The overall prevalence of substance use from the respondents was (62.6%). Specically chat (11.8%), Cigarette (9%), Shisha (2.5%), Alcohol use (65.2%), and the remaining 11.8% use more than two substances This result shows that, (AOR=17.141, 95% CI=2.5-115.2770) using substance by peer friends was higher than who had no peer friends .Male students were 0.6 times more likely use substance than Females students [AOR =0.663 95%CI(0.415-1.061]. Conclusion: In this study area, prevalence of substance use among regular students was relatively high than other studies Friendly use of substances, academically fourth year students and department of accounting students were signicantly associated. Key words: use,


Background
Substance abuse is inappropriate use of drugs or psychoactive substances in which the user consumes the substance with amount or method which are harmful substance. Such as alcohol, khat, and tobacco has become one of the major health problems and socioeconomic problems worldwide (1). Worldwide, 3.3 million deaths every year result from harmful use of alcohol, this represent (5.9%) of all deaths. The harmful use of alcohol is a causal factor in more than 200 disease (2). Tobacco smoking is the leading risk factors for (NCD) has been recognized as the 2 leading cause of death globally (3).
Study stated that tobacco smoking causes 6.3 million deaths annually (4). Disorders due to psychoactive substance use including alcohol, drug, and tobacco dependency were the main underlying conditions ultimately responsible for the largest proportion of the global burden of disease attributable to substance use in sub-Saharan Africa due to rapid economic, social, and cultural transitions that most countries were now experienced. It is estimated that (9%) of the global population aged 12 or older are classi ed with dependence on psychoactive substances such as alcohol (5,6). Heavy consumption of alcohol when shared with chewing chat is associated with many psychological problems including euphoria, hyperactivity, anorexia, insomnia, lethargy and depression (7).
Cigarette smoking and khat chewing among men in Addis Ababa were associated with high blood pressure, an established risk factor for cardiovascular disease (8). In addition, the combined use of Page 3/14 alcohol and chat increase sexual risky behavior contributing to the spread of HIV infection (9).
Substance misuse was growing problems in Ethiopia, as in many developing countries (10). Including university students in Ethiopia, only scant information is available about the magnitude of substance use (11). Furthermore, the effect of mental health status of students such as depression on substance use was not well explored (11,12). This study was assessed the prevalence and associated factors of substance use among Debre tabor university regular students. Substance use: Use of at least one of the substances (alcohol, Chat, cigarettes, and illicit drugs) in an individual's life time to alter mood or behavior.

Study area and Study Period
Substance abuse: Is inappropriate use of drugs or psychoactive substances in which the user consumes the substance with amount or method which are harmful to them or others Current user: A person who consumed any substance at least once in the past 30 days.
Ever user: Use of any of the substances at least once in an individual's life time.
Illicit drugs: The use of psychoactive substances such as hashish, cannabis, and heroin, for which the production, sale, or use is prohibited.
Sample size and Sampling Procedure n=Sample size Z= Value of 95% con dence interval, which is the normal standard deviation=1.96 D= difference in precision or estimate=0.05% P=Prevalence of substance is =34.6% (Research conducted in Woldia Town in 2015 E.C) (13). The estimated sample size is 347 .By adding 10% non-response rates the total sample size was 382. By using reduction formula since the study population less than 10,000 So, NF=n/1+n/N NF =382/1+382/1579 =382/1.242 = 307.7~308 Therefore the nal sample size was 308 Sampling Technique: The sizes of the study population were selected by using proportional allocation and an individual was selected by systematic random sampling technique.

Data collection procedure and tools
The data was collected using 3(BSc degree in midwifery and 2 BSc degrees in Nursing) professionals.
Each question was explained to the students to help their understanding. The data was collected using self-administered structured questionnaire which was prepared in English and then translate to the local language of Amharic and again back to English to con rm the correctness of the tools.
Data analysis.

Data quality assurance
In order to assure data quality, high emphasis was given to minimize errors using the following strategies. The questionnaire was adapted from previous similar literatures (2,3,5,10,11,14)and questionnaire were pretested on 5% of the sample size in Bahirdar university, health science college, subsequent correction and modi cation was done, and proper instruction or training was given before the survey. The collected data's were reviewed and checked for completeness before data entry and strictly supervision was done till end of the data collection.

Result
Socio demographic pro le of substance use In this study a total of 308 regular students were interviewed from Debre Tabor University. The overall response rate was (100%). Among the total respondents (62.6%) respondents were substance use with the mean age of respondents 22.61, standard deviation of 2.637.Majority of them (64.6%) were male students. From the respondents (95.1%) were Amhara and (95.1%) orthodox followers. The places of residence for the majority of respondents, (69.8%) were from urban setting. Less than half respondents were Farmers (40.3%), followed by government employee (26.9%) regarding on family's educational status, Fathers (42.2%), Mothers (30.2%) were unable to read and write and (15.6 %) of Mothers, (7.5%) of Fathers were having college and above.

Discussion
In this study overall prevalence of substance use from the respondents were (62.6%) in their life time. However the study conducted at wolkite university in 2017 out of the total study subjects were (66.9%) of ever use of substance and spastically khat, alcohol, and tobacco 148(32.5%), 299(65.6%) and 108(23.7%) respectively (15), which is almost consistent with this nding at Debre tabor university regular students. The possible reasons may be due to the same cultural traits by economically, food habits including drinking and the same cultivate nature's gifts.
This nding was lower than that with previous study done on cigarette smoking and chat chewing among university students in North West Ethiopia (13.1 %) and (26.7 %)respectively (14). Because of the reasons due to methodological difference, availability of cultivation.
In this nding ever users of khat (42%) and cigarette smokers were (42%) high as compared to study done at Ambo University in 2010E.C (16).Might be due to local availability of chat and socially acceptability of cigarettes and methodological difference. But ever users of alcohol this nding was lower than that with previous study conducted in Wolkite University.
In multivariate logistic regression of this study, male students, peer friends and mothers education of unable to read and write variables was signi cantly associated with substance use (2.526(1.008-6.327)), 3.532(2.098-5.951) and 1.363(1.125-1.652 respectively. However, study done in Jordan University assessed attitude of students toward the idea that person who smokes has more friends than nonsmokers. This is telling us peer friends have highly exposed towards substance used therefore, this study is in line with study done at Jordan university because of peer friends might have dangers for ever things not only substance use that is why 17 th times more likely use substance than not friendly use. Reasons may be due to Peer pressure, it is very powerful factors for in uencing behavioral changes, especially in adolescent stage

Conclusion
The overall prevalence of substance use from the respondents was high in their life time. Maternal education, peer friends use, academically second year students, occupation of farming and male students' interims of sex were signi cantly associated to the substance use.
Limitations of the study the study participants were 16 years and above in order to keep for his/her willingness for generation of data and evidence also keep con dentiality of the information and maintained throughout by making the data collection anonymous names.

Consent for publication:
Not Applicable Availability of data and materials When the ethics statement was obtained from Debre Tabor University, College of health Science, we have agreed and signed not to publish the row data retrieved from the information of the regular students. However, the datasets collected and analyzed for the current study is available from the corresponding author and can be obtained on a reasonable request.

Competing interest
The authors have agreement between, no competing and nancial matters

Funding
The author did not receive funding for this study Substance used by the respondents in Debre tabor university, Amhara, Region, Ethiopia, 2019 (n=308)