INTRODUCTION:

Substance abuse has become a global phenomenon. It has affected almost every country, although its extent and characteristics differ from region to region. It is estimated that at least 40 million people throughout the world are regular substance or drug abusers. The problems of drug abuse are localized especially in the urban, semi-urban and along the border areas of India.1

Prevalence of substance abuse is high among adolescents as they are keen to experiment the drugs to fulfill their curiosity. If their experimentation could be prevented by making them aware about the abuse and its consequences, the prevalence of the substance abuse can be reduced.2

The period of adolescence is a vulnerable period in the life of an individual. The increased vulnerability in this period related to psychological factors like curiosity, poor impulse control, run away from reality, psychological distress and so forth. The social factors like peer influence, lack of clear identity, and self or intra-familial conflict also expose the adolescent to substance abuse.3

The problem of substance abuse is a significant problem among adolescents in our societies as the problem is increasing day by day due to various factors like easy availability and rapid socioeconomic and demographic changes4. Recent studies have shown that the drug addicts registered for treatment and rehabilitation of various treatment centers are mostly adolescents and youth students5. In terms of initiating substance abuse a significant percentage of drug abuser (83%) has started using drug and other substances between 16-20 years followed by under 15 years6.

Substance abuse is associated with a variety of negative consequences, including school failure, and poor judgment which may put adolescents at risk for accidents, violence, unplanned and unsafe sex. These dangerous consequences of substance abuse on human life intensify the need for the prevention of these abuse7.

People abuse substances such as alcohol, tobacco, and other drugs for varied and complicated reasons, but it is clear that our society pays a significant cost. The toll for this abuse can be seen in our hospitals and emergency departments both through direct damage to health by substance abuse and its link to coronary artery disease, cardiovascular and other vascular effects.

Hospitals and clinics tally daily the strong connection between cardiovascular, coronary artery disease and substance dependence and abuse. The use of alcohols, cigarettes, tobacco have increased in recent years tremendously endangering healthy life of the people with some or other long-term impairment of functioning.

The abuse of alcohol is associated with chronic cardiomyopathy, hypertension, and arrhythmia. Abstinence or using alcohol in moderation can reverse these cardiovascular problems. Alcohol is also distinguished among the substances of abuse by having possible protective effects against coronary artery disease and stroke when used in moderate amounts.

Finding effective treatment for and prevention of substance abuse has been difficult. Through research, we now have a better understanding of this behavior. Studies have made it clear that education and prevention aimed at children and adolescents offers the best chance to curb abuse nationally8.

The sooner the teen gets help for drug abuse, the more likely they’ll be to avoid the long-lasting consequences9. The above studies suggested that there is an extent used of substances abuse among the school, college and university going students therefore it becomes important to assess the knowledge of the college going students regarding substance abuse and helps prevent substance abuse among them.

NEED FOR THE STUDY:

Substance abuse is a serious public health problem that affects almost every community and family in some way. Each year substance abuse results in around 40 million serious illnesses or injuries among people in the States¹⁰. Teens who abuse drugs with needles increase their risk of blood-borne diseases like HIV, AIDS and Hepatitis B and C⁹.

Nevertheless, experimentation with substances, particularly alcohol and tobacco, is progressively more common behavior among college students. There is casual relationship between alcohol consumption and more than 60 types of diseases and injury worldwide alcoholism estimated to cause about 20% - 30% of esophageal cancer, liver cancer, and cirrhosis of liver, homicide, epilepsy and motor vehicle accidents. Worldwide 1.8 million deaths and 58.3 million DALY attributed to the use of alcohol¹¹.

Experimentation is considered problematic when substance use occurs at a very young age, with increasing frequency, while the child is alone, or in the context of behavioral or emotional difficulties. If use becomes more frequent, negative consequences can develop, including impairment at school or work, legal problems, accidents, and interpersonal difficulties. Substance use becomes abuse when an adolescent suffers negative and harmful consequences because of the use of substances—and yet continues using. Substance abuse has been strongly linked to risky sexual behavior, delinquent behavior, and low school achievement. Heavy and prolonged substance use can result in drug dependence, with a syndrome of significant distress if the drug use is stopped or reduced¹².

Policies which influence the levels and patterns of substance use and related harm can significantly reduce the public health problems attributable to substance use, and interventions at the health care system level can work towards the restoration of health in affected individuals¹³.

In developing countries, 80 percent of young people are enrolled in schools. Children spend their important time period in school. They can learn and develop own belief, value and vision from the information received and the activities they get involved in school. Therefore, the risk behaviors like drug abuse can be prevented by the necessary education at school¹⁵.

College students are the most vulnerable group and are at high risk of substance abuse related problems compared to other population. The prevalence rate of substance abuse is highest among young adolescents and young adults, a large majority of who are students¹⁶.

Substance abuse by students in secondary schools and colleges is a serious problem. As it is gaining gradual popularity among college students, it would be vital to examine their knowledge towards substance abuse. Health education is an important strategy of all the programs to prevent and control substance abuse¹⁷.

The WHO Expert Committee on Drug Dependence (1973) endeavored to ascertain factors associated with the prevention of drug dependence and urged that it would be necessary to eliminate the ignorance and misconception about drug effects. In many parts of the world, drinking alcoholic beverages is a common feature of social gatherings. In addition to the chronic diseases that may develop in those who drink large amounts of alcohol over a number of years, alcohol use is also associated with an increased risk of acute health conditions, such as injuries, including from traffic accidents¹⁸.

A descriptive study conducted on Tobacco use and cardiovascular disease a knowledge, attitude and practice study in rural Kerala. Present study included 302 (64.7%) females and 165 (35.3%) males. Among the males 44 (38.5%) were ever smokers. Though 451 (96.6%) of the subject knew that tobacco use is harmful for health, only 101(22.5%) of the subject knew that it causes cardiovascular diseases. However more efforts are needed to make them aware about the role of tobacco smoking and chewing in causing cardiac problems¹⁹.

According to the A.D.A.M. Medical Encyclopedia, Smokers have a much higher risk of heart disease as compared to others and it also states that substance abuse is one of the risk factors of coronary heart disease²⁰.

Dr. Banpel (1995) says that prevention is better than cure. People’s health is in their own hands, so we need to educate people and work together as a team.

In addition to this, campus atmosphere and peer pressure is forcing and influencing the adolescents to indulge in drug abuse and alcoholism mainly due to lack of adequate knowledge about the consequences of its use or falsely perceived knowledge and attitude towards drug abuse and alcoholism as the students use drug and alcohol for ‘company, ‘festivity’, or ‘curiosity’. Prevention and education are important aspects of nursing care in any setting.

This impression led the investigator to design the present study that is aimed at assessing the knowledge and attitude regarding substance abuse among students studying in selected Junior College at Kolhapur.

OBJECTIVES:

This chapter deals with the statement of the problem, objectives of the study, assumptions, hypothesis, limitations of the study and conceptual framework. The statement of the problem selected for the study and its objectives are as follows:

STATEMENT OF THE PROBLEM:

“A descriptive study to assess the knowledge and attitude regarding substance abuse among the students studying in D.Y. Patil Junior College at Kolhapur.”

OBJECTIVES OF THE STUDY:

1) To assess the level of knowledge regarding substance abuse among students.

2) To assess the level of attitude regarding substance abuse among students.

3) To find the association between knowledge scores with selected demographic variables regarding substance abuse among students.

4) To find the association between attitude scores with selected demographic variables regarding substance abuse among students.

5) To find the correlation between knowledge and attitude scores regarding substance abuse among students.

Operational Definitions:

Assess: In the this study, it refers to check the extent of knowledge and level of attitude regarding substance abuse among students with the help of structured knowledge questionnaire and attitude scale.

Knowledge:

In this study, it refers to the correct response obtained from students to the knowledge questionnaire regarding meaning, causes, signs and symptoms and treatment regarding substance abuse.

Attitude:

In this study, it refers to the outlook belief and norms of the behavior of the students regarding substance abuse.

Substance abuse:

In this study, it includes alcohol consumption, tobacco chewing and psychoactive substance abuse.

Junior College Students:

In this study, it refers to adolescent in the age group of 16-22 years who are studying in 12th standard.

Hypothesis:

H1- There is a significant association between knowledge scores with selected demographic variables among students regarding substance abuse.

H2- There is a significant association between attitude scores with selected demographic variables among students regarding substance abuse.

H3- There is a significant correlation between knowledge and attitude scores among students regarding substance abuse.

Assumption:

The study assume that students,

1) May have some knowledge regarding substance abuse.

2) May have poor attitude regarding substance abuse.

Delimitations:

The study is limited to,

1) Junior College students.

2) In the group of 16 to 22 years.

3) Who are studying in D.Y. Patil Junior College at Kolhapur.

4) Only to assess knowledge and attitude regarding substance abuse.

METHODOLOGY:

This chapter deals with the description of methodology adopted for the study and different steps taken for gathering and organizing data for the investigation. It includes description of research approach, research design, setting of the study, population, sample, sampling techniques, sampling criteria, development and description of the tools, validation and testing of the tools, reliability of the tools, pilot study, data collection procedure and plan for data analysis and interpretation of data.

The present study has been undertaken to assess the knowledge and attitude regarding substance abuse among students studying in selected Junior College at Kolhapur.

Research Approach:

A research approach tells the researcher what data to collect and how to analyse it. It also suggests possible conclusions to be drawn from the data. In view of the nature of the study, the investigator has adopted the quantitative descriptive survey approach to assess the knowledge and attitude of Junior college students regarding substance abuse.

Research Design:

The selection of the design depends upon the purpose of the study, research approach and variables under study. The research design is an explicit blue print for the research activities to be carried out.

Research design incorporates some of the most important methodological decisions that the researcher makes in conducting a study. A research design is a researcher’s overall plan for testing the research hypothesis.

The research design selected for the study is non-experimental descriptive research design.

Setting of the Study:

The physical location and conditions in which data collection takes place in the study is known as setting. The study was conducted in D. Y. Patil Junior College at Kolhapur.

The criteria for selecting the study setting are the availability of the subjects, feasibility of conducting the study and the investigators familiarity with the setting and population.

Population:

Population is the entire aggregation of cases that meet a designed set of criteria. The population criteria establish the target population and the accessible population.

Target population is the population that the researcher wishes to study and make a generalization. Accessible population refers to the aggregate of cases which conform to the designated criteria and accessible to the researcher. Thus the target population and accessible population were the students studying in selected Junior College at Kolhapur.

Sample and sample size:

A sample is a selected proportion or a subset of units which comprise the population. The sample for the present study included 100 students selected from Selected Junior College at Kolhapur.

Sampling Technique:

Sampling is the process of selecting a portion of the population to represent it. Based on the criteria mentioned above non-probability purposive sampling technique was used to select the sample according to the purpose of study.

Sampling Criteria:

(a) Inclusion Criteria:

1. Students studying in Selected Junior College at Kolhapur.

2. Students who are willing to participate in the study.

(b) Exclusion Criteria:

1. Students who are not available during the period of data collection.

2. Students who are mentally and physically ill.

Development of Tool:

The tool was selected and developed based on the research problem, review of the related literature and with suggestions and guidance of experts in the field of psychiatric nursing, psychiatry, clinical psychology and psychiatric social work.

Description of the Tool:

The tool for data collection comprised of three sections.

Section A:

Demographic data consisting of 13 items seeking information about the baseline data such as age, gender, religion, residential area, type of family, occupation of parents, monthly income of the family, source of income about substance, any known person using substance and whether subject ever used substance.

Section B:

consisted 30 items on knowledge about substance use like effects on occupation, dietary pattern, family, physiological and psychological complications, withdrawal problem, nutrition, social status and effect on central nervous system. It consisted of total 30 items. In knowledge aspect the items were objective type with choosing the most appropriate response for each item. The correct answer was given a score of ‘one’ and wrong answer ‘zero’

Section C:

Consisted of 20 items on attitude regarding substance use including Social condition, family aspect, physical aspect, Personality factors, causative factors, preventive aspect.

In attitude aspect 5 point scale was used with positive statement carried Strongly Agree-5, Agree-4, Undecided-3, Disagree-2, Strongly Disagree-1 and negative statement carried Strongly Agree-1, Agree-2, Undecided-3, Disagree-4 and Strongly Disagree-5.

Data Collection Method:

Prior permission was obtained from the Principal of selected Junior College, to conduct the study. The data was collected on the 26th April 2017. The investigator personally visited each respondent and introduction about the investigator and the purpose of the study was given, and nature of the study was briefly explained. The questionnaire was administered after getting the respondents consent.

Plan for Data Analysis and Interpretation:

The data collected has been analysed by using the descriptive method and inferential statistics. The plan for data analysis is as follows:

1. Organized the data in master sheet.

2. Percentage, Mean and standard deviation to assess the existing knowledge and attitude scores.

3. Association and correlation are analyzed by using inferential statistics.

ANALYSIS AND INTERPRETATION OF DATA.:

The description of the results is the heart of the research project. It is the communication of facts, measurements, and observation gathered by the research worker. In order to find a meaningful outcome to research questions, the collected data must be processed, analysed in some orderly coherent fashion, so that patterns and relationships can be discussed. The term analysis means the computation of certain measures that exist among data groups.

This chapter deals with the analysis and interpretation of data collected to assess the knowledge and attitude regarding substance abuse among students studying in D.Y. Patil Junior College at Kolhapur. The data collected from the 100 students in D. Y. Patil Junior College were tabulated in the master sheet and analysed by using descriptive and inferential statistics based on the objectives of the study.

This part deals with distribution of participants according to their demographic characteristics. Data was analyzed using descriptive statistics and summarized in terms of percentage.

Table 1: Frequency and percentage distribution of sample according to demographic characteristics

Variable	Frequency	Percentage
1. Age
16 to 17 years	87	87%
18 to 19 years	11	11%
20 to 22 years	02	02%
2. Gender
Male	65	65%
Female	35	35%
3. Religion
Hindu	84	84%
Muslim	05	05%
Christian	09	09%
Others	02	02%
4. Residential area
Urban	58	58%
Semi-urban	24	24%
Rural Area	18	18%
5. Type of family
Nuclear	58	58%
Joint	42	42%
6. Parent’s occupation
Govt Service	19	19%
Private Service	36	36%
Self-Employed Business	28 16	28% 16%
Agriculture	01	01%
7. Monthly income of family
<Rs 5000	18	18%
Rs 5000 to 10000	28	28%
Rs 10001 to 15000	20	20%
>Rs 15000	34	34%
8. Source of information regarding substance abuse
a. Radio / Television	60	60%
b. Academic education	06	06%
c. Books/Magazines/Journals	15	15%
d. Health personnel	06	06%
e. Family Members	02	02%
f. Relatives	-	-
g. Friends	11	11%
9. Any of your known person using substance?
a. Yes	23	23%
b. No	77	77%
10. If yes
a. Relatives b. Friends c. Neighbours	08 14 01	35% 61% 04%
11. Have you ever used any substance?
a. Yes	15	15%
b. No	85	85%
12. If yes, who initiated to use substance?
a. Self	02	13%
b. Friends	11	74%
c. Relatives	02	13%
13. Frequency of using substance?
a. Daily	03	03%
b. Weekly	04	04%
c. Fortnightly d. Monthly e. Occasionally f. Never	03 02 02 86	03% 02% 02% 86%

Data presented in Table 1 shows that the majority of respondents (87%) belonged to the age group of 16-17 years whereas 11% belonged to 18-19 years and 2% students belonged to 20-22 years. With regard to gender, majority of respondents (65%) were male and 35% were female. Most the students (84%) belonged to Hindu religion and only 9% were Christians.

The majority (58%) of students were from nuclear family and 42% from joint family. The majority of student’s parentshad private services (36%) and only 1% werefarmers. Majority of studentswere residing in (58%) urban area, 24% were staying in semi-urban and only 18% were staying in rural area. Majority (34%) of students’ family income was above Rs. 15,000 and that of 18% was below Rs. 5,000 rupees per month.

Majority of the students (60%) had get information from radio/television, 15% had get information from books/magazines, 2% had get information from family members and no one had get information from relatives. Majority (77%) of student’s relative/friends had not used substance and 23% of student’s relative/friends use substance.

Most (85%) of students were not using substance and 15% students were using substance. Among this, majority (74%) of students initiated substance use byfriends and 13% by both self and relatives.

Figure 1: Distribution of thesubject according tothe age.

Figure 2: Distribution of the subject according to gender.

Figure 3: Distribution of thesubjects according to the religion.

Part II: Assessment of the Knowledge related to substance abuse among students:

The knowledge related to substance abuse among of studentswas assessed using structured knowledge questionnaire.

Section A: Analysis of the Knowledge related to substance abuse among students.

In order to assess the knowledge related to substance abuse among of students, percentage scores were graded arbitrarily as follows: poor ≤ 10%, average11-20% and good 21-30%.

Table 2: Frequency and percentage distribution of the students according tothe level of knowledge related to substance abuse. N = 100

Level of Knowledge	Range of score	Frequency	Percentage
Poor	≤ 10	07	07%
Average	11 – 20	69	69%
Good	21 - 30	24	24%

Data in Table 2 and Figure 4 show that majority (69%) of the students had average, 24% had poor and 7% had goodlevel of knowledgerelated to substance abuse.

Figure 4: Distribution of students based on the level of knowledge regarding substance abuse.

Part III: Assessment of the Attitude related to substance abuse among students.

Attitude related to substance abuse among students were assessed by using attitude scale.

Section A: Analysis of the Attitude related to substance abuse among students.

Table 3: Frequency and percentage distribution of the students according to attitude related to substance abuse. N = 100

Influence of factors	Range of score	Frequency	Percentage
Negative	20 - 60	21	21%
Positive	61 - 100	79	79%

Data presented in Table 3 and Figure 5 shows that majority (79%) of students had positive attitude towards stoppage of substance abuseand 21% of them had negative attitude towards stoppage of substance abuse.

Figure 5: Distribution of subjects based on attitude towards substance use.

Part IV: Association between the knowledge scores with the selected demographic variables regarding substance abuse among students.

Chi-square test was computed to test the association between the knowledge scores with the selected demographic variables; the following hypothesis was formulated.

H1: There is a significant association between knowledge scores with selected demographic variables among students regarding substance abuse.

The hypothesis was tested using chi-square testat 0.05level of significance.

Table 4: Association between knowledge scores with selected demographic variables regarding substance abuse among students.

N=100

Sr. No	Demographic variables	Df	Calculated value (χ2)	Table value	Inference
1.	Age	4	5.931	9.49	NS
2.	Gender	2	0.704	5.99	NS
3.	Religion	6	6.116	12.59	NS
4.	Residence	4	17.584	9.49	S
5.	Family	4	6.230	9.49	NS
6.	Occupation	8	4.026	15.51	NS
7.	Income	6	8.398	12.59	NS
8.	Information	10	11.134	18.31	NS
9.	Person using	2	5.736	5.99	NS
10.	If yes	6	8.714	12.59	NS
11.	Used substance	4	2.852	9.49	NS
12.	Initiated	6	8.357	12.59	NS
13.	Frequency	10	20.174	18.31	S

NS = Not Significant

S = Significant

The data presented in Table 4 shows that the obtained Chi-square values indicate a significant association between the knowledge scores of students with both residence and frequency respectively (17.584 and 20.174 at 0.05 levels). But there is no significant association between the knowledge scores of students and other demographic variables such as age, gender, religion, type of family, occupation, income, Information, person using, if yes, used substance and initiated.

However, the above finding reveals that there was association betweenthe knowledge scores of studentswith both residence and frequency respectively. So the hypothesis (H1) was accepted.

Part V: Association between the attitude scores with the selected demographic variables regarding substance abuse among students.

Chi-square test was computed to test the association between the attitude scores with the selected demographic variables; the following hypothesis was formulated.

H2: There is a significant association between attitude scores with selected demographic variables among students regarding substance abuse.

The hypothesis was tested using chi-square testat 0.05level of significance.

Table 5: Association between attitude scores with selected demographic variables regarding substance abuse among students.

N=100

Sr. No	Demographic variables	Df	Calculated value (χ2)	Table value	Inference
1.	Age	2	1.634	5.99	NS
2.	Gender	1	3.530	3.84	NS
3.	Religion	3	0.552	7.82	NS
4.	Residence	2	0.274	5.99	NS
5.	Family	2	0.390	5.99	NS
6.	Occupation	4	1.012	9.49	NS
7.	Income	3	7.130	7.82	NS
8.	Information	5	7.110	11.07	NS
9.	Person using	1	0.922	3.84	NS
10.	If yes	3	5.562	7.82	NS
11.	Used substance	2	0.564	5.99	NS
12.	Initiated	3	1.600	7.82	NS
13.	Frequency	5	2.657	11.07	NS

NS = Not significant

S = Significant

The data presented in Table 5 shows that the obtained Chi-square values indicate that there is no significant association between the attitude scores of students and demographic variables such as age, gender, religion, residence, type of family, occupation, income, Information, person using, if yes, used substance, initiated and frequency.

Therefore, the above finding reveals that there was no association betweenthe attitude scores of students and demographic variables. So the hypothesis (H2) was not accepted.

Part VI: Correlation between the knowledge and attitude scores regarding substance abuse among students.

To test the correlation between theknowledge and attitude scores regarding substance abuse among students, the following hypothesis was formulated:

H3: There is a significant correlation between knowledge and attitude scores among students regarding substance abuse.

Karl Pearson’s correlation coefficient was used to find the correlation between the knowledge scores and attitude scores regarding substance abuse among students. The Karl Pearson correlation coefficient was 0.507, which is greater than table value at 0.01 level of significance. So the null hypothesis was rejected and the research hypothesis accepted.

CONCLUSION:

The present study was conducted to assess the knowledge regarding of mental illness in adults of rural area at Kolhapur, with following objectives:

1) To assess the level of knowledge regarding mental illness among adults of rural area.

2) To find the association between knowledge scores regarding mental illness with selected demographic variables among adults of rural area.

The following conclusions are drawn from the study:

Majority of the adults participated in the study have knowledge on general information about mental illness and gave free and frank responses regarding mental illness. The study was based on the general system model. It provides a comprehensive frame work for assessment of knowledge and attitude of adults regarding mental illness.

The research approach used is descriptive study and the samples were selected by using non-probability purposive sampling technique. Data was collected by means of structured questionnaire, attitude scale and analyzed, interpreted by applying statistical methods.

THE FINDINGS OF THE STUDY:

The results also reveals that majority (70%) of the rural adults had good knowledge, 16% had average and 14% had very good level of knowledge related to mental illness.

The Chi-square values indicate a significant association between the knowledge scores of rural adults with income (calculated value 15.831 is more than table value 9.49 at 0.05 levels). However, the above finding reveals that there was association between the knowledge scores of adults with income. So the hypothesis (H₁) was accepted.

IMPLICATIONS OF THE STUDY:

The findings of the study have implications for the nursing profession. The implications have been written under the following headings, nursing practice, nursing administration, nursing education, nursing research and general education in schools and colleges.

Nursing Practice:

1. It can be included in the health educational programme, which should be carried out in high schools, colleges, and in community.

2. Teaching parents to provide children with a secure and healthy home environment to avoid mental illness.

3. Nurses can motivate adolescents to abstain from mental illness as they frequently encounter them in clinical settings.

Nursing Education:

1. Nursing curriculum is responsible for preparing future nurses with emphasis on curative, preventive and promotive health practices.

2. Nurse educators should give more importance to mental illness in the curriculum as they are dealing with adolescent adults, who are future nurses and need to have adequate knowledge in educating and preventing the community from mental illness.

3. Need to conduct in-service education for nurses and health workers.

Nursing Administration:

Nurse administrators in the hospitals, in the community can organize in-service education for nurses and health awareness camps for the community about mental illness and it consequences.

1. Adequate information materials regarding mental illness and its ill effects made available to all nurses, health personnel and to the public.

Nursing Research:

1. The descriptive survey provides baseline for conducting other research studies.

2. The study will be a motivation for budding researchers to conduct similar studies on a large scale.

3. The study will be a reference for research scholars.

General Education in Schools and Colleges:

1. Schools and colleges may include mental illness in the curriculum.

2. Seminars and discussions on mental illness and its ill effects need to be organized.

LIMITATIONS:

1. No broad generalization could be made due to the small sample size and limited area of setting.

RECOMMENDATIONS:

1. A similar study needs to be conducted in other colleges in order to generalization.

2. A similar study can be done on a large sample for the generalization.

3. A teaching programme for the teachers about the consequences of mental illness in campus must be periodically done to enhance their knowledge.

4. A comparative study can be taken up to assess the knowledge of adults regarding mental illness.

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Received on 13.09.2019 Modified on 12.10.2019

Int. J. Nur. Edu. and Research. 2020; 8(1):23-31.

DOI: 10.5958/2454-2660.2020.00005.8