|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2022 | Volume
: 19
| Issue : 2 | Page : 132-138 |
|
Factors associated with 12-month psycho-active substance use among police officers in Kano Metropolis, Kano, Nigeria
Kefas J Kwaghe1, Fatimah I Tsiga-Ahmed2, Taiwo G Amole2, Musa M Bello2, Rabiu I Jalo2, Aminatu A Kwaku3, Usman I Ibrahim3, Hadiza M Abdullahi2, Aliyu Aminu3
1 Nigeria Police Medical Services, Nigeria Police Academy, Wudil-Kano, Nigeria
2 Department of Community Medicine, College of Health Sciences, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Community Medicine, Aminu Kano Teaching Hospital; Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| Date of Submission | 05-Oct-2021 |
| Date of Decision | 26-Jun-2022 |
| Date of Acceptance | 30-Jun-2022 |
| Date of Web Publication | 23-Nov-2022 |
Correspondence Address:
Fatimah I Tsiga-Ahmed
Department of Community Medicine, College of Health Sciences Bayero University Kano/Aminu Kano Teaching Hospital, Kano
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/njbcs.njbcs_56_21
Context: Substance use is a widely recognized and pressing public health issue with grave consequences. It is important to prevent mishaps of substance use among the police. Aim: This study assessed the prevalence and factors associated with 12-month psycho-active substance use among police officers in Kano, Nigeria. Settings and Design: A cross-sectional study was conducted among police officers serving within metropolitan Kano. Methods and Materials: Pre-validated, adapted, semi-structured questionnaires were used to collect socio-demographic, work-related data and information on psycho-active substance use. Statistical Analysis Used: Multi-variate logistic regression modeling was used to determine factors associated with psycho-active substance use. All analyses were performed using STATA/IC 15.0. Results: Among 275 officers with a mean age of 35.1 ± 7.7 years, 14.9% (n = 41) recently used one or more psycho-active substances within the last 12 months, and tobacco was the most commonly used (n = 41, 100%). A lower likelihood of substance use was found among officers who were in their fifth decade of life (aOR = 0.29, 95% CI: 0.10–0.55), had tertiary education (aOR = 0.32, 95% CI: 0.14–0.77), were inspectors (aOR = 0.15, 95% CI: 0.16–0.61), were at the rank of ASP or higher (aOR = 0.58, 95% CI: 0.30–0.78), and had been in service between 16 and 20 years (aOR = 0.23, 95% CI: 0.11–0.65). Conclusion: Demographic and work-related characteristics influence the use of psycho-active substances among police officers in Nigeria. There is a need to revamp existing substance monitoring strategies to avoid catastrophic consequences of substance use among the society's gatekeepers.
Keywords: Determinants, Nigeria, police, psycho-active substance
How to cite this article:
Kwaghe KJ, Tsiga-Ahmed FI, Amole TG, Bello MM, Jalo RI, Kwaku AA, Ibrahim UI, Abdullahi HM, Aminu A. Factors associated with 12-month psycho-active substance use among police officers in Kano Metropolis, Kano, Nigeria. Niger J Basic Clin Sci 2022;19:132-8 |
How to cite this URL:
Kwaghe KJ, Tsiga-Ahmed FI, Amole TG, Bello MM, Jalo RI, Kwaku AA, Ibrahim UI, Abdullahi HM, Aminu A. Factors associated with 12-month psycho-active substance use among police officers in Kano Metropolis, Kano, Nigeria. Niger J Basic Clin Sci [serial online] 2022 [cited 2023 Mar 21];19:132-8. Available from: https://www.njbcs.net/text.asp?2022/19/2/132/361894 |
| Introduction | |  |
A substance is defined as any psycho-active compound with the potential to cause health and social problems, including addiction.[1] Substance use is a global incident, affecting almost every country. Across the globe, in 2017, 5.5% of individuals between 15 and 64 years (271 million) had used drugs in the previous year, of which 53.4 million were users of opioids.[2] In Nigeria, the prevalence of drug use among people aged between 15 and 64 years was 14.4% in 2017.[3] Harmful use of substances is one of the leading risk factors affecting population health worldwide.[4] The 2018 World Drug report stated that in 2017, across the globe, 585,000 people died from complications of drug use, and 35 million people suffer from drug use disorders.[2]
Police work is perhaps one of the most stressful jobs characterized by grief-stricken and traumatizing incidents. Studies have shown that stress has a strong positive effect on substance use.[5],[6] Given the hectic nature of police life, people in the police force are vulnerable to psycho-active substance use. Some police officers reported substance use as a means to reduce stress, hide their vulnerability, and socialize and blend in with their colleagues.[7] Varying figures on substance use have been reported among police in different countries. In Bosnia–Herzegovina, cannabis was the most common illegal drug used by Spanish military police (36.2%), 14.9% of them used cocaine, and amphetamines were used by 12.1%.[8] Among military police units in the Brazilian state of Goiás, use was reported by 2.34%.[9] A similar study from Rio de Janeiro, Brazil, reported the use of tranquillizers in the past year (13.3% by civil police and 10.1% by military police). The consumption of marijuana among officers was 0.1% by civil police and 1.1% by military police, and cocaine use among the military police was 1.1%.[10]
In Uganda, 19.2% of the surveyed country's police met the criteria for alcohol use disorder, and 26.0% met the criteria for alcohol use problems.[11] Although substance use has been reported across various occupations in Nigeria, use among police officers is yet to be documented. Among soldiers from a southwestern state, 6.7% were engaged in non-medical prescription opioid use (NMPOU), and 3.6% had non-medical prescription opioid use disorder (NMPOUD).[12] The prevalence of lifetime cannabis use was 13.5%, and the 12-month use was 6.8%.[13] The lifetime alcohol use was 76.0%, and the 12 month prevalence was 53.9%.[14]
Our study seeks to assess the prevalence of recent substance use (12-month use) among police officers in Kano, Nigeria. Considering the repercussions of substance use among police, who are the gatekeepers of security in every community, findings from this study would provide data upon which preventive measures can be developed to ensure that there are no accidents resulting from substance use.
| Methods | | |
Study setting
Kano is one of the 36 states of the Federal Republic of Nigeria, and it is in the Northwest geo-political zone of the country. The state has a 2020 estimated population of 13,699,563 projected at 2.6% per annum growth from the 2006 census.[15] Kano state consists of 44 local Government areas, of which eight are regarded as metropolitan. There are six police area commands within the metropolis. Each area command comprises between five and eight divisions, headed by a Divisional Police Officer (DPO).
Study design/Sampling
A cross-sectional survey of a sample of police officers serving in the area commands within Kano metropolis was conducted. Police officers were sampled using a three-stage sampling approach. First, from the six area commands within the Kano metropolis, two commands were randomly selected. We then selected two divisions from each chosen area command through balloting. All police officers serving in the four divisions selected were invited to participate in the study. Our study size was estimated based on requirements for the sample size of a single proportion.[16] We used a national prevalence of 14.4%,[3] a statistical power of 80%, and a precision of 0.05. The estimated sample size was increased by 10% to account for non-response giving a total of 210.
Study population
All serving police officers who were available during the study period and consented were surveyed. Severely sick officers and those who were on leave were excluded. Participation was entirely voluntary.
Data collection
Data were collected from 274 police officers between May 3 and July 31, 2019. An adapted,[17] semi-structured, pre-tested, self-administered questionnaire was used to obtain information on the socio-demographic characteristics of the respondents and the prevalence and pattern of substance abuse. Questionnaires were handed out to the officers during their breaks, and submission was into a designated box from which they were retrieved daily.
Substance use
For this study, the use of any prescription or over-the-counter drug for non-medical reasons and the use of any illegal substance or tobacco and alcohol were regarded as substance use. 'Recent use or 12 months use' (last-12-months prevalence) was defined as any substance use during the past 12 months, whereas 'lifetime use' (lifetime prevalence/experience) was defined as any substance use during the respondent's life.
Substance use was assessed using questions L1, L2, L3, and L4 from the drug section (section L) of version 2.1 of the Composite International Diagnostic Interview (CIDI-Core).[17] Answers were dichotomized as “Yes” or “No”. The questionnaire made a list of substances available, and respondents were expected to choose either yes or no for use. Respondents also provided information to write out other substances that were not in the list. Answering 'yes' to any of the questions was regarded as “substance use”.
Explanatory variables
These were mainly socio-demographic and work-related characteristics of the respondents.
Statistical analysis
All analyses were performed using STATA/IC version 15.0 (Stata Corp, College Station, TX, USA).
Mean and standard deviation were used to summarize numeric data. Frequencies and percentages were obtained for categorical variables. As appropriate, Pearson's Chi-square or Fisher's exact test was used to assess the association between socio-demographic and work-related variables and current substance use. The type I error was fixed at 5% for all tests. Binary logistic regression models were developed for recent substance use, and independent variables with P < 0.10 at the bivariate level were included in the logistic regression model. Adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) were used to measure the strength and direction of the effect of factors independently associated with recent substance use.
Ethical approval
Ethical approval was obtained from the Kano State Health Research Ethics Committee (Reference – MOH/Off/797/T.I/1254), and permission was obtained from Nigeria Police headquarters, Bompai, Kano (Reference – AB: 3380/KNS/DFA/VOL. 2/267). Signed informed consent was obtained from all the respondents.
| Results | | |
A total of 275 police officers participated in this study. The respondents ranged from 20 to 58 years, with a mean age (±SD) of 35.1 ± 7.7 years. Almost half of the respondents (n = 128, 46.5%) were in the age range of 30–39 years, with 25.5% (n = 70) in their third decade. The majority were males (n = 256, 93.1%), and 68.4% were of the Hausa tribe (n = 229). A greater part (n = 247, 89.8%) of the participants were Muslims, and 64% (n = 176) were married. More than half of the respondents (n = 170, 61.8%) had secondary education, and a sizeable number (n = 110, 40.0%) were sergeants. Only 8.7% (n = 24) of the respondents had a history of deployment outside Nigeria (n = 42). The socio-demographic and workplace characteristics of the participants are shown in [Table 1]. | Table 1: Socio-demographic and workplace characteristics of respondents, Kano, Nigeria
Click here to view |
Prevalence and pattern of psycho-active substance use among police officers
Fifteen percent of the police officers (n = 41) admitted to using one or more psycho-active substances recently, and the lifetime prevalence of substance use was 34.1% (n = 75). All recent users (n = 41) reported tobacco use, and 51.2% (n = 21) used alcohol. Cannabis was used by 48.8% (n = 20) of the respondents, and 39.0% (n = 16) used cocaine. Almost half (n = 18, 43.9%) of the respondents said that they used substances 3 or 4 days a week, ten officers (24.4%) used substances on 1–2 days a week, and eight police officers (19.5%) used it almost every day. Almost a fifth (n = 8, 19.5%) indicated using substances while on duty, and 22.0% of the respondents (n = 9) admitted to having used more than one substance at a time [Table 2].
Factors associated with psycho-active substance use among police officers
At the bivariate level, respondents' age, number of children, educational qualification, years in service, and present rank were found to be significantly associated with substance use (P < 0.05) [Table 3]. | Table 3: Factors associated with substance use among police officers, Kano, Nigeria
Click here to view |
[Table 4] summarizes the logistic regression findings between the study's independent variables and substance use. Factors independently associated with substance use were respondents' age, educational qualification, years in service, and present rank. Odds of substance use were lower among officers in their fifth decade of life compared to those in the third decade (aOR = 0.29, 95% CI: 0.10–0.55) compared to those in their third decade. Similarly, respondents who were educated up to the tertiary level were also 70% less likely to use substances compared to those whose highest education was a secondary school (aOR = 0.32, 95% CI: 0.14–0.77). Compared to respondents who were presently constables, Inspectors (aOR = 0.15, 95% CI: 0.16–0.61) and Assistant Superintendents of Police (ASPs) and higher ranks (aOR = 0.58, 95% CI: 0.30–0.78) were found to have a lower odds of substance use. Respondents who were in police service between 16 and 20 years were also less likely to use substances compared to those who had been in service for 5 years or less (aOR = 0.23 95%, CI: 0.11–0.65). | Table 4: Logistic regression model for factors associated with substance use among police officers, Kano, Nigeria
Click here to view |
| Discussion | | |
This study found a relatively high lifetime and 12-month prevalence of psycho-active substance use among police officers in Kano, with almost half of users reporting usage on at least 3–4 days a week. Tobacco, alcohol, and cannabis were the most frequently used substances, and over a quarter reported poly-substance use.
Age, educational qualification, years in service, and present ranks were independently associated with substance use. The prevalence of substance use reported here is much higher than that reported from a zonal survey,[18] and a similar study among Brazilian police,[9] but comparable to the national prevalence reported by the United Nations Office on Drugs in 2018 and the figure found among Polish soldiers.[3],[19] This may be because regional surveys often have higher sample sizes and may include individuals with a lower risk of substance use, thus giving a lower prevalence in the general public. Additionally, the stressful events which predispose individuals to partake in the consumption of these substances vary among the populace. Contextual differences between Nigeria and Brazil may also exist, and operational definitions of 'substance use' between the studies vary.
Analogous to our findings, tobacco and alcohol, individually or in combination, have been consistently reported as the most frequently used substances in different populations within Nigeria.[20],[21],[22],[23],[24] This finding may not be unrelated to the fact that both are legalized substances, readily available, and sold everywhere. Moreover, tobacco use has been shown to increase the use of alcohol, cannabis, and other substances in Cameroon, Ethiopia, Zimbabwe, Iran, Wales, USA, and Australia.[25],[26],[27],[28],[29],[30],[31] Studies have also reported a strong relationship between alcohol and marijuana and an even stronger association between marijuana and tobacco.[32],[33] It is not uncommon to find out that the use of other substances began with smoking cigarettes or drinking alcohol, with the fact that these are legal substances which are more accessible. In Norway, the use of cannabis was found to complement alcohol consumption, and in Germany, a tenth of alcohol users transitioned to the use of other substances over time.[34],[35] This can also be bolstered by the fact that a sizeable number of the users practiced poly-substance use.
Akin to other studies, our results also revealed that cannabis and cocaine were used quite commonly.[3],[8],[9],[18] This is not unusual, with the fact that the amount of cocaine seized in 2017 was 74% higher than that seized in the past decade and cannabis is by far the most widely cultivated and trafficked substance globally.[2] Although planting or growing cannabis is considered a serious offence in Nigeria, it is grown widely throughout the country. Further, the average daily expenditure of N363 ($0.90) on cannabis, as reported among users in Nigeria,[3] is less than 1% of the minimum monthly wage for a police officer in the country, thus promoting affordability and improving use. Additionally, the use of cannabis is reported to be much higher among urban residents and the male gender.[18] Our study population was entirely urban, with 93.1% males.
About a fifth of the officers used more than one substance simultaneously or concurrently. Higher proportions of multiple substance use were reported among a much younger population of secondary schools and a University in Nigeria and from adolescents in USA.[36],[37],[38] The disparities in the results could be attributed to the difference in age groups of the participants. The poly-substance use observed in this study was higher among younger officers. Curiosity may drive individuals to try out different substances at a young age.
Our results show that a younger age increased the odds of substance use even after adjusting for education, rank, years in service, ethnic group, marital status, and history of ever-seeking help. Studies have documented an increase in health-compromising behavior in the younger age groups relative to the older population.[39],[40],[41],[42] There is also evidence that the pattern of risky behavior changes as individuals grow older.[43] Perhaps, the young police officers newly exposed to the organizational and traumatic stressors of work seek solace in substances. This could explain why police officers with fewer years of service in this study also had a higher prevalence of substance use. Findings from a study suggested that the police service and training process introduced recruits to alcohol consumption.[44] Our results are in tandem with studies outside the police force, which found a higher prevalence of substance use among younger individuals.[45],[46]
Consistent with reports from Iran[47] and Thailand,[42] a lower educational status was found to influence substance use in this study. Education is often considered a fundamental determinant of health and an essential marker of socio-economic status. Officers with a tertiary degree have higher ranks, more resources, and increased access to health information. On the other hand, lower police ranks may predispose officers to more physical and psychosocial risks leading to substance use. Furthermore, the communities within which these lower ranks reside may increase their access to different substances. A study found that disadvantaged and middle-class neighborhoods increased the risk of substance abuse among younger residents.[48] Another study revealed that the influence of neighborhood on substance abuse might operate through an increase in the frequency of stressful life events in neighborhoods with low levels of income and education, followed by the use of substances to cope with these events, differential availability of substances in these settings, and insufficient resources to overcome substance use once initiated.[49]
As with all studies, the findings from this study must be viewed within the context of its strengths and limitations. The cross-sectional nature of this study signifies that definitive conclusions about the direction of associations between study variables cannot be made, and relationships do not denote causality. Additionally, substance use was assessed via self-reporting, and no confirmatory test or independent source of information was available to confirm the actual status of the participants. Although some users may not wish to disclose their actual state, it is unlikely that non-users would present themselves as users. Nonetheless, a minimal effect of this is expected as the assessment tool was a standard self-administered tool.
This study underscores the burden of psychoactive substance use among police officers in Nigeria and shows that demographic and work-related characteristics influence its use. To our knowledge, this is the first study that identifies factors independently associated with substance use among Nigerian police. Evaluating psycho-active substance use among police officers is critically important to prevent addiction with its attendant psycho-social consequences and promote public safety. Our findings indicate the need for the Nigerian Police Force to re-evaluate the organization's strategies in routine substance use monitoring, especially among high-risk officers. Periodic confirmatory urinary and blood testing should be the norm. There is also a need to strengthen substance education and counselling, support and refer users to treatment facilities, and re-integrate rehabilitated users into suitable units. A collaboration involving more police units and commands from different geographical parts of the country may provide more robust findings.
Acknowledgements
The Nigerian Police Headquarters, Kano.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | McLellan AT. Substance misuse and substance use disorders: Why do they matter in healthcare? Trans Am Clin Climatol Assoc 2017;128:112-30.  |
| 2. | United Nations Office on Drugs and Crime (UNODC). World Drug Report 2019. United Nations publication, Sales no. E19XI8, 2019. |
| 3. | United Nations Office On Drugs And Crime. Drug Use in Nigeria. United Nations Office On Drugs And Crime, 2018. |
| 4. | World Health Organization. Global status report on alcohol and health 2018. Geneva, 2018. |
| 5. | Ballenger JF, Best SR, Metzler TJ, Wasserman DA, Mohr DC, Liberman A, et al. Patterns and predictors of alcohol use in male and female urban police officers. Am J Addict 2011;20:21-9. |
| 6. | Liberman AM, Best SR, Metzler TJ, Fagan JA, Weiss DS, Marmar CR. Routine occupational stress and psychological distress in police. Policing 2002;25:421–39. |
| 7. | Dietrich JF, Smith J. The nonmedical use of drugs including alcohol among police personnel: A critical literature review. J Police Sci Admi 1986;14:200-6. |
| 8. | Vargas Pecino C, Castellano E, Trujillo H. Factors associated with substance use among Spanish military personnel involved in “Bosnia-Herzegovina”. Adicciones 2017;28;29:163-71. |
| 9. | Costa SH, Yonamine M, Ramos AL, Oliveira FG, Rodrigues CR, da Cunha LC. Prevalence of psychotropic drug use in military police units. Cien Saude Colet 2015;20:1843-9. |
| 10. | De Souza ER, Schenker M, Constantino P, Correia BS. Consumption of licit and illicit substances by police officers in the city of Rio de Janeiro. Cien Saude Colet 2013;18:667-76. |
| 11. | Ovuga E, Madrama C. Burden of alcohol use in the Uganda Police in Kampala District. Afr Health Sci 2006;6:14-20. |
| 12. | Lasebikan VO, Ijomanta I. Nonmedical prescription opioid use and opioid use disorder in the military population in Nigeria. J Subst Use 2019;24:192-8. |
| 13. | Lasebikan VO, Ijomanta IN. Lifetime and 12 months cannabis use and disorders among soldiers residing in a military community in Nigeria. J Subst Use 2018;23:67-73. |
| 14. | Ijomanta IN, Lasebikan VO. Lifetime and 12 months prevalence of alcohol use and alcohol use disorders among soldiers residing in a military community in Ibadan. Subst Use Misuse 2016;51:722-32. |
| 15. | Nigerian Population Commission. Nigerian Census 2006. Federal Republic of Nigeria Official Gazzette; 2009. p. B31-2. |
| 16. | Lwanga SK LS. Sample Size Determination in Health Studies: A Practical Manual. Geneva, Switzerland: World Health Organization; 1991. p. 29-32 |
| 17. | World Health Organization. Composite International Diagnostic Interview (CIDI) CORE version 2.1. Division of Mental Health, editor. Geneva, Switzerland, 1997. |
| 18. | Adamson TA, Ogunlesi AO, Morakinyo O, Akinhanmi AO, Onifade PO, Erinosho O, et al. Descriptive national survey of substance use in Nigeria. J Addict Res Ther 2015;6:234. |
| 19. | Jedrzejczak M, Kocur J. Threat of drug addiction in the army. Psychiatria Pol 2003;37:511-8. |
| 20. | Odivwri JE, Wudil P. Substances abuse among commercial tricycle riders in Kano Metropolis, Nigeria. Int J Educ Res 2014;2:535-44. |
| 21. | Gudaji MI, Habib ZG. Sociodemographic factors associated with psychoactive substance use among commercial motorcycle operators in Kano, Nigeria. OJPsych 2015;6:76-85. |
| 22. | Ibrahim AW, Sale S. Prevalence, predictors and patterns of psychoactive substance use among HIV seropositive adults at Aminu Kano Teaching Hospital Kano, North Western Nigeria. Int J Med Med Sci 2014;1:81-90. |
| 23. | Gudaji M, Habib Z. Prevalence of psychoactive substance use among registered commercial motorcycle operators in Kano, North Western Nigeria: A community study. Int J Med Med Sci 2016;8:105-11. |
| 24. | Yunusa U, Bello UL, Idris M, Haddad MM, Adamu D. Determinants of substance abuse among commercial bus drivers in Kano Metropolis, Kano State, Nigeria. Am J Nurs Sci 2017;6:125-30. |
| 25. | Degenhardt L, Hall W. The relationship between tobacco use, substance-use disorders and mental health: Results from the National Survey of Mental Health and Well-being. Nicotine Tob Res 2001;3:225-34. |
| 26. | Lewinsohn PM, Rohde P, Brown RA. Level of current and past adolescent cigarette smoking as predictors of future substance use disorders in young adulthood. Addiction 1999;94:913-21. |
| 27. | Deressa W, Azazh A. Substance use and its predictors among undergraduate medical students of Addis Ababa University in Ethiopia. BMC Public Health 2011;11:660. |
| 28. | Shahraki G, Sedaghat Z, Fararouei M. Family and social predictors of substance use disorder in Iran: A case-control study. Subst Abuse Treat Prev Policy 2019;14:17. |
| 29. | Mbanga CM, Efie DT, Aroke D, Njim T. Prevalence and predictors of recreational drug use among medical and nursing students in Cameroon: A cross sectional analysis. BMC Res Notes 2018;11:515. |
| 30. | Rudatsikira E, Maposa D, Mukandavire Z, Muula AS, Siziya S. Prevalence and predictors of illicit drug use among school-going adolescents in Harare, Zimbabwe. Ann Afr Med 2009;8:215-20. [ PUBMED] [Full text] |
| 31. | Wadsworth EJ, Moss SC, Simpson SA, Smith AP. Factors associated with recreational drug use. J Psychopharmacol 2004;18:238-48. |
| 32. | Jackson KM, Sher KJ, Schulenberg J E. Conjoint developmental trajectories of young adult substance use. Alcohol Clin Exp Res 2008;32:723-37. |
| 33. | Cohn A, Villanti A, Richardson A, Rath JM, Williams V, Stanton C, et al. The association between alcohol, marijuana use, and new and emerging tobacco products in a young adult population. Addict Behav 2015;48:79-88. |
| 34. | Tomczyk S, Pedersen A, Hanewinkel R, Isensee B, Morgenstern M. Polysubstance use patterns and trajectories in vocational students--A latent transition analysis. Addict Behav 2016;58:136-41. |
| 35. | Pape H, Rossow I, Storvoll EE. Under double influence: Assessment of simultaneous alcohol and cannabis use in general youth populations. Drug Alcohol Depend 2009;101:69-73. |
| 36. | Makanjuola AB, Daramola TO, Obembe AO. Psychoactive substance use among medical students in a Nigerian university. World Psychiatry 2007;6:112-4. |
| 37. | Igwe W, Ojinnaka N, Ejiofor S, Emechebe G, Ibe B. Socio-demographic correlates of psychoactive substance abuse among secondary school students in Enugu, Nigeria. Eur J Soc Sci 2009;12:1-7. |
| 38. | Moss HB, Chen CM, Yi HY. Early adolescent patterns of alcohol, cigarettes, and marijuana poly-substance use and young adult substance use outcomes in a nationally representative sample. Drug Alcohol Depend 2014;136:51-62. |
| 39. | Rhodes N, Pivik K. Age and gender differences in risky driving: The roles of positive affect and risk perception. Accid Anal Prev 2011;43:923-31. |
| 40. | Turner C, McClure R. Age and gender differences in risk-taking behaviour as an explanation for high incidence of motor vehicle crashes as a driver in young males. Int J Contr Saf Promot 2003;10:123-30. |
| 41. | Fitzpatrick KM, La Gory ME, Ritchey FJ. Factors associated with health-compromising behavior among the homeless. J Health Care Poor Underserved 2003;14:70-86. |
| 42. | Tantirangsee N, Assanangkornchai S. Prevalence, patterns, associated factors and severity of substance use among psychotic patients in southern Thailand. Asian J Psychiatr 2015;13:30-7. |
| 43. | Cebulla A, Tomaszewski W. Risky Behaviour and Social Activities. Department for Children, Schools and Families, National Centre for social research Research Report DCSF-RR173. UK, 2009. |
| 44. | Obst PL, Davey JD, Sheehan MC. Does joining the police service drive you to drink? A longitudinal study of the drinking habits of police recruits. Drugs Educ Prev Pol 2001;8:347-57. |
| 45. | Addington J, Addington D. Patterns, predictors and impact of substance use in early psychosis: A longitudinal study. Acta Psychiatr Scand 2007;115:304-9. |
| 46. | Torchalla I, Strehlau V, Li K, Krausz M. Substance use and predictors of substance dependence in homeless women. Drug Alcohol Depend 2011;118:173-9. |
| 47. | Barati M, Ahmadpanah M, Soltanian AR. Prevalence and factors associated with methamphetamine use among adult substance abusers. J Res Health Scis 2014;14:221-6. |
| 48. | Karriker-Jaffe KJ. Neighborhood socioeconomic status and substance use by U.S. adults. Drug Alcohol Depend 2013;133:212-21. |
| 49. | Galea S, Ahern J, Tracy M, Rudenstine S, Vlahov D. Education inequality and use of cigarettes, alcohol, and marijuana. Drug Alcohol Depend 2007;90(Suppl 1):S4-15. |
[Table 1], [Table 2], [Table 3], [Table 4]
|
Search Pubmed for