CERCETARE

Factori de risc şi factori de rezilienţă privind consumul de droguri la adolescenţii din România

 Risk and resilience factors for adolescent drug use in Romania

Radu-Flaviu Oroian, Bogdan Nemeș, Prof. dr. Doina Cozman

First published: 20 septembrie 2018

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/Psih.54.3.2018.1914

Abstract

Introduction. Studying the adolescent’s risk and resilience factors towards drug use is an important step in understanding and developing functional prevention strategies. 
Aim. The present study assesses the risk and resilience factors towards drug use in an adolescent population from Romania. 
Methodology. The current study is nested in the Working in Europe to Stop Truancy Among Youth (WE-STAY) Framework Programme 7 project, funded by the European Commission. A total number of 1730 adolescents were included. The mean age was 16.6 years old, with a standard deviation of 0.6 years. A total of 980 participants (56.9%) were females. We used the WE-STAY baseline questionnaire to collect the data. WE-STAY specific questions were used to assess age, sex, if the participants lived with both parents, if any of the parents worked abroad, if the participants considered they were religious persons, having a stable boyfriend/girlfriend, bulliyng perception, alcohol consumption, if they ever used drugs, what type of drugs, if a family member used drugs, physical injury related to risk behaviors, if they smoked, and if a family member smoked. 
Results. Out of the total sample, 8.3% reported having used drugs. The category of drugs most frequently reported were cannabinoids, and the least frequently reported were opiates. The adolescents who used drugs registered significantly higher conduct problems, hyperactivity, externalising and total difficulties scores, while also registering significantly lower prosocial scores. 
Conclusions. Some of the highest risk factors for adolescents to ever use illicit drugs in Romania are: 16+ years old, male gender, alcohol consumption, cigarette smoking, previous drug use, and family members using drugs.

Keywords
drugs, adolescents, risk, resilience, Romania

Rezumat

Introducere. Studierea factorilor de risc şi a factorilor de rezilienţă ai adolescenţilor privind consumul de droguri reprezintă un pas important în înţelegerea şi dezvoltarea unor strategii funcţionale de prevenţie. 
Scop. Studiul de faţă evaluează factorii de risc şi factorii de rezilienţă privind consumul de droguri în cadrul unei populaţii de adolescenţi din România.
Metodologie. Studiul îşi are originea în proiectul Working in Europe to Stop Truancy Among Youth (WE-STAY) Framework Programme 7, finanţat de Comisia Europeană. Un număr total de 1730 de adolescenţi au fost incluşi. Media de vârstă a fost de 16,6 ani, cu o deviaţie standard de 0,6 ani. Dintre participanţi, 980 (56,9%) au fost de sex feminin. Am utilizat chestionarul standard WE-STAY pentru colectarea datelor. Chestionarele WE-STAY au fost utilizate pentru a evalua următoarele variabile: vârsta, sexul, dacă participanţii locuiau cu ambii părinţi, dacă unul dintre părinţi locuia în străinătate, dacă participanţii se considerau a fi persoane religioase, dacă aveau un prieten/prietenă stabilă, percepţia privind bullyingul, consumul de alcool, dacă au consumat vreodată droguri, ce tip de droguri, dacă unul din membrii familiei consuma droguri, răni legate de consumul de droguri, dacă fumau, dacă unul din membrii familiei consuma droguri.
Rezultate. Din eşantionul total, 8,3% au menţionat că au consumat droguri. Categoria de droguri utilizată cel mai frecvent au fost canabinoidele, iar categoria utilizată cel mai rar au fost opiaceele. Adolescenţii care au consumat droguri au avut semnificativ mai multe probleme de comportament, hiperactivitate, scorurile de externalizare şi de dificultate totale au fost mai mari, în acelaşi timp obţinând scoruri prosociale semnificativ mai mici.
Concluzii. Unii dintre cei mai importanţi factori de risc privind consumul de droguri la adolescenţi sunt: vârsta peste 16 ani, sexul masculin, consumul de alcool, fumatul, consumul de droguri în trecut, membri din cadrul familiei care consumă droguri.

Introduction

Studying the adolescent’s risk and resilience factors towards drug use is an important step in understanding and developing functional prevention strategies.

The risk of lifelong substance use is increased with early adolescent use, according to a study conducted in 2017. The same study also states that neurodevelopment is affected by the early substance use, which leads to neurobiologic changes that further increase the risk of substance use(1).

Some low-risk characteristics such as good relationship with parents and beliefs that drug use is problematic are already noted by other recent studies, which concluded that the results may help in developing preventive strategies targeting drug-exposed adolescents(2).

The link between self-esteem and resilience is highlighted by a study from Slovakia, using the Rosenberg Self-Esteem Scale and the resiliency scale, answering questions about smoking and cannabis use(3). Boys with low self-esteem tended to have a higher level of risk. Resilience was higher in boys and girls who had a better family cohesion. Social competence, on the other hand, was associated with higher risk of consuming cannabis, concluding that prevention should not be focused only on individual characteristics, but also on the family and social network.

The present study assesses the risk and resilience factors towards drug use in an adolescent population from Romania.

Materials and method

Study design

The current study is nested in the Working in Europe to Stop Truancy Among Youth (WE-STAY) Framework Programme 7 project, funded by the European Commission(4). The WE-STAY project is a randomised control clinical trial testing mental health prevention strategies (professional screening and increase of awareness). For the purposes of the present study, we used the baseline data of Romanian adolescents.

The study protocol was approved by the Research Ethics Committee of the “Iuliu Haţieganu” University of Medicine and Pharmacy from Cluj-Napoca and respects all applicable ethics reglementations, including the Declaration of Helsinki. An opt-out inclusion strategy was used to ensure legal tutor consent and adolescent assent.

Participants

A total number of 1730 adolescents were included. The mean age was 16.6 years old, with a standard deviation of 0.6 years. A total of 980 participants (56.9%) were females.

Method

We used the WE-STAY baseline questionnaire to collect the data. WE-STAY specific questions were used to assess age, sex, if the participants lived with both parents, if any of the parents worked abroad, if the participants considered they were religious persons, having a stable boyfriend/girlfriend, bulliyng perception, alcohol consumption, if they ever used drugs, what type of drugs, if a family member used drugs, physical injury related to risk behaviors, if they smoked, and if a family member smoked.

The Strenghts and Difficulties Questionnaire (SDQ) was used to screen for psychopathology, and Kendler’s Life Events Checklist was used to assess for stressful events in the previous year.

Statistical analysis

Data analysis was performed using the Statistical Pack for Social Sciences v.22.0. The Chi Square Test or Fisher’s Exact Test was used to evaluate the distribution of qualitative data across groups. The Student’s t Test or Mann-Whitney U Test was used to test for differences in quantitative data distribution across groups. The Kolmogorov-Smirnov Test was used to assess normality of data distribution.

Results

Out of the total sample, 8.3% reported having used drugs. The category of drugs most frequently reported were cannabinoids and the least frequently reported were opiates (Figure 1), with 21.5% of users having used two or more substance categories.
 

Figure 1. Types of drugs used
Figure 1. Types of drugs used

In general, adolescents who ever tried drugs are significantly older than those who never used drugs (mean rank 857.37 vs. 767.09; p=0.015; Mann-Whitney U Test) – Figure 2.
 

Figure 2. Age related to drug use
Figure 2. Age related to drug use

Male sex induces a 2.025 higher risk of ever having used drugs than female sex (95% CI; 1.412-2.904), with 11.5% of male adolescents ever having used drugs versus only 6% in females.

Not living with both parents does not seem to confer a significant risk for using drugs (OR=1.499; 95% CI; 0.985-2.281; p=0.057; 2 test), with the same being true for having at least one parent working abroad (OR=1.979; 95% CI; 0.912-4.293; p=0.080; 2 test).

Religiosity, on the other hand, seems to be a protective factor, reducing the risk to around a quarter (OR=0.256; 95% CI; 0.174-0.377; p≤0.01; 2 test).

Having a steady girlfriend/boyfriend does not seem to influence the risk (OR=1.003; 95% CI; 0.698-1.442; p=0.985; 2 test).

Adolescents that did use drugs registered significantly higher conduct problems, hyperactivity, externalising and total difficulties scores, while also registering significantly lower prosocial scores (Table 1).
 

Table 1. The strenghts and difficulties questionnaire results
Table 1. The strenghts and difficulties questionnaire results

Smoking increases the risk for drug use (OR=9.754; 95% CI; 6.359-14.962; p<0.001; 2 test), as does problematic alcohol use (OR=8.100; 95% CI; 5.542-11.840; p<0.001; 2 test).

Another member of the family using drugs significantly increases the risk of the adolescent ever having used drugs (OR=13.343; 95% CI; 4.759-37.409; p<0.001; Fischer’s Exact test).

Discussion

In this study, we assessed the resilience and risk factors regarding drug use in an adolescence population from Romania. We evaluated the demographic and social characteristics, along with different types of behaviors (i.e., alcohol consumption, previous drug use, and smoking).

From a demographic point of view, adolescents who ever tried drugs are significantly older than those who never used drugs. Moreover, male sex has over two times higher risk of ever having used drugs than female sex.

Most used drugs among adolescent users are cannabinoids and the least frequently reported are opiates. This could be explained by the fact that cannabinoids are easier to procure and cheaper than other drugs(5). Also, this type of drugs is considered “safer”. It is a known fact that cannabis is a gateway drug, leading to other types of drug use. This is particularly dangerous because synthetic drugs are even easier to procure and cheaper. They are extremely dangerous, as new classes emerge all the time(6).

A lot of Romanian adolescents have parents working abroad. We wanted to see if this is a risk factor to be taken into consideration. Our statistic data shows that having any of the parents working abroad does not seem to confer a significant risk for using drugs. The same is true for adolescents not living with both parents.

As other studies showed, religiousness seems to be a protective factor for adolescents who consider themselves religious(7,8). In our study, the difference between adolescents who consider themselves religious and adolescents who don’t consider themselves religious is significant. The risk is four times higher for the latter group.

Having a stable boyfriend or girlfriend does not seem to affect the balance between risk and resilience factors regarding drug use.

Problematic alcohol consumption and cigarette smoking among adolescents represent a higher risk of consuming illegal substances compared to the adolescents who do not smoke or consume alcohol. This finding was expected, since many other studies have underlined this(9-11). These are both new and old studies, which prove that there is a strong link between smoking, problematic alcohol consumption and illicit drug use.

From the WE-STAY baseline questionnaire(4), we calculated The Strengths and Difficulties Questionnaire (SDQ)(12) for all the Romanian adolescents. Significantly higher hyperactivity, conduct problems, total difficulties scores and externalising were registered by adolescents who previously used drugs. This group also registered significantly lower prosocial scores. This results are in line with other studies(13-15), which suggest that prevention strategies should be targeted in the early adolescence, if not sooner.

The risk of the adolescent for having used drugs is greatly increased if a family member is using drugs. This is a point of view less studied so far, to our knowledge. Our study has a large number of participants and showed a high risk, but a study from 2009, with 19 adolescents(16), showed a subjective risk and protective factors, derived from subjective perceptions. We believe further studies are needed regarding family members drug use and the implications that adolescents are subjected to.

Conclusions

From the results of the present study, several important conclusions can be drawn. First of all, 8.3% of the Romanian adolescents reported ever having used drugs. Secondly, the most used drugs in Romania by the adolescent population are cannabinoids. Lastly, some of the highest risk factors for adolescents to ever use illicit drugs in Romania are: older age, male gender, alcohol consumption, cigarette smoking, previous drug use and family member using drugs.  

Conflict of interest. The authors declare that there are no conflicts of interests.