Determinants of alcohol drinking and its association with sexual practices among high school students in Addis Ababa, Ethiopia: Cross sectional study
ABSTRACT
Introduction: Alcohol drinking and risky sexual practices have become serious public health problem among teenagers and young adults globally, including many developing countries. The available reports are sparse, especially there is a lack of recent and representative data for high school students in developing countries including Ethiopia. The aim of this study was to estimate the prevalence, identify determinants, and examine the association of alcohol drinking with sexual practices among high school students in Addis Ababa, capital city of Ethiopia. Methods: School based cross sectional study was conducted from November to December 2010. Multivariate logistic regression analysis was used to determine the association between students’ background characteristics and alcohol use, and alcohol use and sexual practices. Results: Among 2551 students surveyed, lifetime and current (past month) alcohol drinking was reported by 1166 (45.7%) and 676 (26.5%) students, respectively. Having sexual intercourse at least once in their lifetime was reported by 412 (16.2%) with151 (5.9%) of them being sexually active during a month prior to the survey. Having multiple sexual partners (52.5%), drinking alcohol before sexual intercourse (26.4%), and having sexual intercourse without the use of condom (47.3%) were also common among sexually active students. In adjusted logistic regression model, age (18 and 19 and older), living with 2 parents, getting pocket money, having alcohol drinking friends and attending general secondary school (grade 9-10) were positive predictors of current alcohol drinking. Nergative predictors of current alcohol drinking were being Protestant Christian and living with relatives or siblings. Conclusion: Alcohol drinking before sexual intercourse was a major problem among high school students in Addis Ababa, Ethiopia. Male gender, older age and higher school grade, friends influence, religious affiliation, living with parents and getting pocket money were significant predictors of current alcohol drinking. Educating about substance use and risky sexual behaviors, engaging students in extracurricular activities and restrict access to alcohol to high school students may help in solution of these problems on a local scale.
Introduction: Alcohol drinking and risky sexual practices have become serious public health problem among teenagers and young adults globally, including many developing countries. The available reports are sparse, especially there is a lack of recent and representative data for high school students in developing countries including Ethiopia. The aim of this study was to estimate the prevalence, identify determinants, and examine the association of alcohol drinking with sexual practices among high school students in Addis Ababa, capital city of Ethiopia. Methods: School based cross sectional study was conducted from November to December 2010. Multivariate logistic regression analysis was used to determine the association between students’ background characteristics and alcohol use, and alcohol use and sexual practices. Results: Among 2551 students surveyed, lifetime and current (past month) alcohol drinking was reported by 1166 (45.7%) and 676 (26.5%) students, respectively. Having sexual intercourse at least once in their lifetime was reported by 412 (16.2%) with151 (5.9%) of them being sexually active during a month prior to the survey. Having multiple sexual partners (52.5%), drinking alcohol before sexual intercourse (26.4%), and having sexual intercourse without the use of condom (47.3%) were also common among sexually active students. In adjusted logistic regression model, age (18 and 19 and older), living with 2 parents, getting pocket money, having alcohol drinking friends and attending general secondary school (grade 9-10) were positive predictors of current alcohol drinking. Nergative predictors of current alcohol drinking were being Protestant Christian and living with relatives or siblings. Conclusion: Alcohol drinking before sexual intercourse was a major problem among high school students in Addis Ababa, Ethiopia. Male gender, older age and higher school grade, friends influence, religious affiliation, living with parents and getting pocket money were significant predictors of current alcohol drinking. Educating about substance use and risky sexual behaviors, engaging students in extracurricular activities and restrict access to alcohol to high school students may help in solution of these problems on a local scale.
Cite this paper
Teshome, D. and Gedif, T. (2013) Determinants of alcohol drinking and its association with sexual practices among high school students in Addis Ababa, Ethiopia: Cross sectional study. Open Journal of Preventive Medicine, 3, 420-427. doi: 10.4236/ojpm.2013.36057.
Teshome, D. and Gedif, T. (2013) Determinants of alcohol drinking and its association with sexual practices among high school students in Addis Ababa, Ethiopia: Cross sectional study. Open Journal of Preventive Medicine, 3, 420-427. doi: 10.4236/ojpm.2013.36057.
References
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[6] Garretsen, H.F., Bongers, I.M., van Oers, J.A. and van de Goor, L.A. (1999) The development of alcohol consumption and problem drinking in Rotterdam 1980-1994: More problem drinking amongst the young and the middle aged. Alcohol, 34, 733-40. doi:10.1093/alcalc/34.5.733 [7] Kim, J.H., Lee, S., Chow, J., Lau, J., Tsang, A., Choi, J. and Griffiths, S.M. (2008) Prevalence and the factors associated with binge drinking, alcohol abuse, and alcohol dependence: A population-based study of Chinese adults in Hong Kong. Alcohol, 43, 360-370. doi:10.1093/alcalc/agm181 [8] Donovan, J.E. (2005) Problem behaviour theory. In: Flisher, C.B. and Lerner, R.M. Eds., Encyclopedia of Applied Development Science. 2nd Edition, Thousand Oaks, Sage, 872-877. [9] Bellis, M.A., Hughes, K., Calafat, A., Juan, M., Ramon, A., Rodriguez, J.A., Mendes, F., Schnitzer, S. and Phillips-Howard, P. (2008) Sexual uses of alcohol and drugs and the associated health risks: A cross sectional study of young people in nine European cities. BMC Public Health, 8, 155. doi:10.1186/1471-2458-8-155 [10] Best, D., Rawaf, S., Rowley, J., Floyd, K., Manning, V. and Strang, J. (2000) Drinking and smoking as concurrent predictors of illicit drug use and positive drug attitudes in adolescents. Drug and Alcohol Dependence, 60, 319-321. doi:10.1016/S0376-8716(00)00113-7 [11] Stueve, A. and O’Donnell, L.N. (2005) Early alcohol initiation and subsequent sexual and alcohol risk behaviors among urban youths. American Journal of Public Health, 95, 887-893. doi:10.2105/AJPH.2003.026567 [12] NIDA (2010) The science of addiction—Drugs, brains and behaviours. NIH Pub No. 10-5605. [13] Martin, J., Barry, J. and Skally, M. (2011) Alcohol attributable hospitalisations and costs in Ireland, 2000-2004. Irish Medical Journal, 104, 140-144. [14] Fekadu, A., Alena, A. and Hanlon, C. (2007) Alcohol and drug abuse in Ethiopia: Past, present and future. African Journal of Drug & Alcohol Studies, 6, 39-53. [15] Kassaye, M., Sherief, H., Fissehaye, G. and Teklu, T. (1999) “Drug” use among high school students in Addis Ababa and Butajira. Ethiopian Journal of Health Development, 13, 101-106. [16] Carter, M., McGee, R., Taylor, B. and Williams, S. (2007) Health outcomes in adolescence: associations with family, friends and school engagement. Journal of Adolescent Health, 30, 51-62. doi:10.1016/j.adolescence.2005.04.002 [17] Bishop, D.I., Weisgram, E.S., Holleque, K.M., Lund, K.E. and Wheeler-Anderson, J.R. (2005) Identity development and alcohol consumption: Current and retrospective selfreports by college students. Journal of Adolescent Health, 28, 523-533. doi:10.1016/j.adolescence.2004.10.007 [18] Sychareun, V., Thomsen, S., Faxelid, E. (2011) Concurrent multiple health risk behaviors among adolescents in Luangnamtha province, Lao PDR. BMC Public Health, 11, 1-10. doi:10.1186/1471-2458-11-36 [19] Poelen, E.A.P., Scholte, R.H.J., Engels, R.C.M.E., Boomsmab, D.I. and Willemsen, G. (2005) Prevalence and trends of alcohol use and misuse among adolescents and young adults in the Netherlands from 1993 to 2000. Drug & Alcohol Dependence, 79, 413-421. doi:10.1016/j.drugalcdep.2005.03.020 [20] Ahlstrom, S.K. and Osterberg, E.L. (2005) International perspectives on adolescent and young adult drinking. Alcohol Research and Health, 28, 258-268. doi:10.1186/1471-2458-12-527 [21] Bennett, L.A., Campillo, C., Chandrashekar, C.R. and Gureje, O. (1998) Alcoholic beverage consumption in India, Mexico, and Nigeria: A cross-cultural comparison. Alcohol Health and Research World, 22, 243-252. [22] Benjet, C., Borges, G., Medina-Mora, M.E., Blanco, J., Zambrano, J., Orozco, R., et al. (2007) Drug use opportunities and the transition to drug use among adolescents from the Mexico City Metropolitan Area. Drug & Alcohol Dependence, 90, 128-134. doi:10.1016/j.drugalcdep.2007.02.018 [23] Andersen, A., Holstein, B.E. and Due, P. (2007) Schoolrelated risk factors for drunkenness among adolescents: Risk factors differ between socio-economic groups. European Journal of Public Health, 17, 27-32. doi:10.1093/eurpub/ckl071 [24] Hung, C.C., Yen, L.L. and Wu, W.C. (2009) Association of parents’ alcohol use and family interaction with the initiation of alcohol use by sixth graders: A preliminary study in Taiwan. BMC Public Health, 9, 172. doi:10.1186/1471-2458-9-172 [25] Fothergill, K.E. and Ensminger, M.E. (2006) Childhood and adolescent antecedents of drug and alcohol problems: A longitudinal study. Drug & Alcohol Dependence, 82, 61-76. doi:10.1016/j.drugalcdep.2005.08.009 [26] Brooks, F.M., Magnusson, J., Spencer, N. and Morgan, A. (2012) Adolescent multiple risk behaviour: An asset approach to the role of family, school and community. Journal of Public Health (Oxford), 34, i48-i56. doi:10.1093/pubmed/fds001 [27] Becerra, D. and Castillo, J. (2011) Culturally protective parenting practices against substance use among adolescents in Mexico. Journal of Substance Use, 16, 136-149. doi:10.3109/14659891.2010.518199 [28] CSA (2012) Ethiopia statical annual abstarct 2011. http://www.csa.gov.et/index.php?option=com_rubberdoc&view=doc&id=421&format=raw&Itemid=606 [29] Central Statistical Agency of Ethiopia (2008) Summary and statistical report of the 2007 population and housing census: Population size by age and sex. Federal Democratic Republic of Ethiopia Population Census Commission. [30] Addis Ababa Education Bureau (2010) Education statistics annual abstract 2008/09. Addis Ababa: Educational management information system (EMIS)—Study, plan and budget support process city government. [31] ESPAD (2008) Methodology. http://www.espad.org/methodology [32] Berhane, Y. and Worku, A. (2007) Alcohol and Khat consumption and the association with HIV/AIDS prevention, care and treatment in Ethiopia: Final report. Addis Continental Institute of Public Health. [33] Reda, A., Moges, A., Wondmagegn, B. and Biadgilign, S. (2012) Alcohol drinking patterns among high school students in Ethiopia: A cross-sectional study. BMC Public Health, 12, 1-6. doi:10.1186/1471-2458-12-213 [34] Rudatsikira, E., Maposa, D., Mukandavire, Z., Muula, A.S. and Siziya, S. (2009) Prevalence and predictors of illicit drug use among school-going adolescents in Harare, Zimbabwe. Annals of African Medicine, 8, 215-220. doi:10.4103/1596-3519.59574 [35] Chaveepojnkamjorn, W. and Pichainarong, N. (2011) Current drinking and health-risk behaviors among male high school students in central Thailand. BMC Public Health, 11, 233. doi:10.1186/1471-2458-11-233 [36] Sturua, L., Baramidze, L., Gamkrelidze, A. and Galdava, G. (2010) Alcohol use in Georgian students; pilot study rigorously following criteria of European school project on alcohol and other drug. Georgian Medical News, 179, 52-61. [37] Shimane, T. and Wada, K. (2007) Substance use among night high school students in Japan. Nihon Arukoru Yakubutsu Igakkai Zasshi, 42, 152-164. [38] Miller, J.W., Naimi, T.S., Brewer, R.D. and Jones, S.E. (2007) Binge drinking and associated health risk behaveiors among high school students. Pediatrics, 119, 76-85. doi:10.1542/peds.2006-1517 [39] Alikasifoglu, M., Erginoz, E., Ercan, O., Uysal, O., Albayrak-Kaymak, D. and Ilter, O. (2004) Alcohol drinking behaviors among Turkish high school students. The Turkish Journal of Pediatrics, 46, 44-53. [40] Chikere, E.I. and Mayowa, M.O. (2011) Prevalence and perceived health effect of alcohol use among male undergraduate students in Owerri, South-East Nigeria: A descriptive cross-sectional study. BMC Public Health, 11, 118. doi:10.1186/1471-2458-11-118 [41] Siziya, S., Muula, A.S., Kazembe, L.N. and Rudatsikira, E. (2008) Harmful lifestyles’ clustering among sexually active in-school adolescents in Zambia. BMC Pediatrics, 8, 6. doi:10.1186/1471-2431-8-6 [42] Minstry of Education (MoE) (2009) Ethiopia-education system. http://www.ethiopia.gov.et/English/MOE/Information/Pages/Fact%20Sheets.aspx [43] Madu, S.N. and Matla, M.Q. (2003) Illicit drug use, cigarette smoking and alcohol drinking behaviour among a sample of high school adolescents in the Pietersburg area of the Northern Province, South Africa. Journal of Adolescence, 26, 121-136. doi:10.1016/S0140-1971(02)00120-3 [44] Ihunwo, A.O., Kayanja, F.I. and Amadi-Ihunwo, U.B. (2004) Use and perception of the psychostimulant, khat (Catha edulis) among three occupational groups in south western Uganda. East African Medical Journal, 81, 468-473. doi:10.4314/eamj.v81i9.9223 [45] Gelaw, Y. and Haile-Amlak, A. (2004) Khat chewing and its socio-demographic correlates among the staff of Jimma University. Ethiopian Journal of Health Development, 18, 179-184. [46] Rudatsikira, E., Dondog, J., Siziya, S. and Muula, A.S. (2008) Prevalence and determinants of adolescent cigarette smoking in Mongolia. Singapore Medical Journal, 49, 57-62. [47] Denny, S.J., Robinson, E.M., Utter, J., Fleming, T.M., Grant, S., Milfont, T.L., et al. (2011) Do schools influence student risk-taking behaviors and emotional health symptoms? Journal of Adolescent Health, 48, 259-267. doi:10.1016/j.jadohealth.2010.06.020 [48] Brian, K.B. and Joseph, A.O. (2004) Assessing the transitions to middle and high school. Journal of Adolescent Research, 19, 3-30. doi:10.1177/0743558403258113 [49] Gnadt, B. (2006) Religiousness, current substance use, and early risk Indicators for substance abuse in nursing students. Journal of Addictions Nursing, 17, 151-158. doi:10.1080/10884600600862103
[1] Fatusi, A.O. and Hindin, M.J. (2010) Adolescents and youth in developing countries: Health and development issues in context. Journal of Adolescence, 33, 499-508. doi:10.1016/j.adolescence.2010.05.019 [2] WHO (2011) Adolescent health. http://www.who.int/topics/adolescent_health/en/ [3] McCarthy, W.J., Mistry, R., Lu, Y., Patel, M., Zheng, H. and Dietsch, B. (2009) Density of tobacco retailers near schools: effects on tobacco use among students. American Journal of Public Health, 99, 2006-2013. doi:10.2105/AJPH.2008.145128 [4] DuRant, R.H., Smith, J.A., Kreiter, S.R. and Krowchuk, D.P. (1999) The relationship between early age of onset of initial substance use and engaging in multiple health risk behaviors among young adolescents. Archives of Pediatrics & Adolescent Medicine, 153, 286–291. doi:10.1001/archpedi.153.3.286 [5] WHO (2011) Global status report on alcohol and health. World Health Organization, Geneva. [6] Garretsen, H.F., Bongers, I.M., van Oers, J.A. and van de Goor, L.A. (1999) The development of alcohol consumption and problem drinking in Rotterdam 1980-1994: More problem drinking amongst the young and the middle aged. Alcohol, 34, 733-40. doi:10.1093/alcalc/34.5.733 [7] Kim, J.H., Lee, S., Chow, J., Lau, J., Tsang, A., Choi, J. and Griffiths, S.M. (2008) Prevalence and the factors associated with binge drinking, alcohol abuse, and alcohol dependence: A population-based study of Chinese adults in Hong Kong. Alcohol, 43, 360-370. doi:10.1093/alcalc/agm181 [8] Donovan, J.E. (2005) Problem behaviour theory. In: Flisher, C.B. and Lerner, R.M. Eds., Encyclopedia of Applied Development Science. 2nd Edition, Thousand Oaks, Sage, 872-877. [9] Bellis, M.A., Hughes, K., Calafat, A., Juan, M., Ramon, A., Rodriguez, J.A., Mendes, F., Schnitzer, S. and Phillips-Howard, P. (2008) Sexual uses of alcohol and drugs and the associated health risks: A cross sectional study of young people in nine European cities. BMC Public Health, 8, 155. doi:10.1186/1471-2458-8-155 [10] Best, D., Rawaf, S., Rowley, J., Floyd, K., Manning, V. and Strang, J. (2000) Drinking and smoking as concurrent predictors of illicit drug use and positive drug attitudes in adolescents. Drug and Alcohol Dependence, 60, 319-321. doi:10.1016/S0376-8716(00)00113-7 [11] Stueve, A. and O’Donnell, L.N. (2005) Early alcohol initiation and subsequent sexual and alcohol risk behaviors among urban youths. American Journal of Public Health, 95, 887-893. doi:10.2105/AJPH.2003.026567 [12] NIDA (2010) The science of addiction—Drugs, brains and behaviours. NIH Pub No. 10-5605. [13] Martin, J., Barry, J. and Skally, M. (2011) Alcohol attributable hospitalisations and costs in Ireland, 2000-2004. Irish Medical Journal, 104, 140-144. [14] Fekadu, A., Alena, A. and Hanlon, C. (2007) Alcohol and drug abuse in Ethiopia: Past, present and future. African Journal of Drug & Alcohol Studies, 6, 39-53. [15] Kassaye, M., Sherief, H., Fissehaye, G. and Teklu, T. (1999) “Drug” use among high school students in Addis Ababa and Butajira. Ethiopian Journal of Health Development, 13, 101-106. [16] Carter, M., McGee, R., Taylor, B. and Williams, S. (2007) Health outcomes in adolescence: associations with family, friends and school engagement. Journal of Adolescent Health, 30, 51-62. doi:10.1016/j.adolescence.2005.04.002 [17] Bishop, D.I., Weisgram, E.S., Holleque, K.M., Lund, K.E. and Wheeler-Anderson, J.R. (2005) Identity development and alcohol consumption: Current and retrospective selfreports by college students. Journal of Adolescent Health, 28, 523-533. doi:10.1016/j.adolescence.2004.10.007 [18] Sychareun, V., Thomsen, S., Faxelid, E. (2011) Concurrent multiple health risk behaviors among adolescents in Luangnamtha province, Lao PDR. BMC Public Health, 11, 1-10. doi:10.1186/1471-2458-11-36 [19] Poelen, E.A.P., Scholte, R.H.J., Engels, R.C.M.E., Boomsmab, D.I. and Willemsen, G. (2005) Prevalence and trends of alcohol use and misuse among adolescents and young adults in the Netherlands from 1993 to 2000. Drug & Alcohol Dependence, 79, 413-421. doi:10.1016/j.drugalcdep.2005.03.020 [20] Ahlstrom, S.K. and Osterberg, E.L. (2005) International perspectives on adolescent and young adult drinking. Alcohol Research and Health, 28, 258-268. doi:10.1186/1471-2458-12-527 [21] Bennett, L.A., Campillo, C., Chandrashekar, C.R. and Gureje, O. (1998) Alcoholic beverage consumption in India, Mexico, and Nigeria: A cross-cultural comparison. Alcohol Health and Research World, 22, 243-252. [22] Benjet, C., Borges, G., Medina-Mora, M.E., Blanco, J., Zambrano, J., Orozco, R., et al. (2007) Drug use opportunities and the transition to drug use among adolescents from the Mexico City Metropolitan Area. Drug & Alcohol Dependence, 90, 128-134. doi:10.1016/j.drugalcdep.2007.02.018 [23] Andersen, A., Holstein, B.E. and Due, P. (2007) Schoolrelated risk factors for drunkenness among adolescents: Risk factors differ between socio-economic groups. European Journal of Public Health, 17, 27-32. doi:10.1093/eurpub/ckl071 [24] Hung, C.C., Yen, L.L. and Wu, W.C. (2009) Association of parents’ alcohol use and family interaction with the initiation of alcohol use by sixth graders: A preliminary study in Taiwan. BMC Public Health, 9, 172. doi:10.1186/1471-2458-9-172 [25] Fothergill, K.E. and Ensminger, M.E. (2006) Childhood and adolescent antecedents of drug and alcohol problems: A longitudinal study. Drug & Alcohol Dependence, 82, 61-76. doi:10.1016/j.drugalcdep.2005.08.009 [26] Brooks, F.M., Magnusson, J., Spencer, N. and Morgan, A. (2012) Adolescent multiple risk behaviour: An asset approach to the role of family, school and community. Journal of Public Health (Oxford), 34, i48-i56. doi:10.1093/pubmed/fds001 [27] Becerra, D. and Castillo, J. (2011) Culturally protective parenting practices against substance use among adolescents in Mexico. Journal of Substance Use, 16, 136-149. doi:10.3109/14659891.2010.518199 [28] CSA (2012) Ethiopia statical annual abstarct 2011. http://www.csa.gov.et/index.php?option=com_rubberdoc&view=doc&id=421&format=raw&Itemid=606 [29] Central Statistical Agency of Ethiopia (2008) Summary and statistical report of the 2007 population and housing census: Population size by age and sex. Federal Democratic Republic of Ethiopia Population Census Commission. [30] Addis Ababa Education Bureau (2010) Education statistics annual abstract 2008/09. Addis Ababa: Educational management information system (EMIS)—Study, plan and budget support process city government. [31] ESPAD (2008) Methodology. http://www.espad.org/methodology [32] Berhane, Y. and Worku, A. (2007) Alcohol and Khat consumption and the association with HIV/AIDS prevention, care and treatment in Ethiopia: Final report. Addis Continental Institute of Public Health. [33] Reda, A., Moges, A., Wondmagegn, B. and Biadgilign, S. (2012) Alcohol drinking patterns among high school students in Ethiopia: A cross-sectional study. BMC Public Health, 12, 1-6. doi:10.1186/1471-2458-12-213 [34] Rudatsikira, E., Maposa, D., Mukandavire, Z., Muula, A.S. and Siziya, S. (2009) Prevalence and predictors of illicit drug use among school-going adolescents in Harare, Zimbabwe. Annals of African Medicine, 8, 215-220. doi:10.4103/1596-3519.59574 [35] Chaveepojnkamjorn, W. and Pichainarong, N. (2011) Current drinking and health-risk behaviors among male high school students in central Thailand. BMC Public Health, 11, 233. doi:10.1186/1471-2458-11-233 [36] Sturua, L., Baramidze, L., Gamkrelidze, A. and Galdava, G. (2010) Alcohol use in Georgian students; pilot study rigorously following criteria of European school project on alcohol and other drug. Georgian Medical News, 179, 52-61. [37] Shimane, T. and Wada, K. (2007) Substance use among night high school students in Japan. Nihon Arukoru Yakubutsu Igakkai Zasshi, 42, 152-164. [38] Miller, J.W., Naimi, T.S., Brewer, R.D. and Jones, S.E. (2007) Binge drinking and associated health risk behaveiors among high school students. Pediatrics, 119, 76-85. doi:10.1542/peds.2006-1517 [39] Alikasifoglu, M., Erginoz, E., Ercan, O., Uysal, O., Albayrak-Kaymak, D. and Ilter, O. (2004) Alcohol drinking behaviors among Turkish high school students. The Turkish Journal of Pediatrics, 46, 44-53. [40] Chikere, E.I. and Mayowa, M.O. (2011) Prevalence and perceived health effect of alcohol use among male undergraduate students in Owerri, South-East Nigeria: A descriptive cross-sectional study. BMC Public Health, 11, 118. doi:10.1186/1471-2458-11-118 [41] Siziya, S., Muula, A.S., Kazembe, L.N. and Rudatsikira, E. (2008) Harmful lifestyles’ clustering among sexually active in-school adolescents in Zambia. BMC Pediatrics, 8, 6. doi:10.1186/1471-2431-8-6 [42] Minstry of Education (MoE) (2009) Ethiopia-education system. http://www.ethiopia.gov.et/English/MOE/Information/Pages/Fact%20Sheets.aspx [43] Madu, S.N. and Matla, M.Q. (2003) Illicit drug use, cigarette smoking and alcohol drinking behaviour among a sample of high school adolescents in the Pietersburg area of the Northern Province, South Africa. Journal of Adolescence, 26, 121-136. doi:10.1016/S0140-1971(02)00120-3 [44] Ihunwo, A.O., Kayanja, F.I. and Amadi-Ihunwo, U.B. (2004) Use and perception of the psychostimulant, khat (Catha edulis) among three occupational groups in south western Uganda. East African Medical Journal, 81, 468-473. doi:10.4314/eamj.v81i9.9223 [45] Gelaw, Y. and Haile-Amlak, A. (2004) Khat chewing and its socio-demographic correlates among the staff of Jimma University. Ethiopian Journal of Health Development, 18, 179-184. [46] Rudatsikira, E., Dondog, J., Siziya, S. and Muula, A.S. (2008) Prevalence and determinants of adolescent cigarette smoking in Mongolia. Singapore Medical Journal, 49, 57-62. [47] Denny, S.J., Robinson, E.M., Utter, J., Fleming, T.M., Grant, S., Milfont, T.L., et al. (2011) Do schools influence student risk-taking behaviors and emotional health symptoms? Journal of Adolescent Health, 48, 259-267. doi:10.1016/j.jadohealth.2010.06.020 [48] Brian, K.B. and Joseph, A.O. (2004) Assessing the transitions to middle and high school. Journal of Adolescent Research, 19, 3-30. doi:10.1177/0743558403258113 [49] Gnadt, B. (2006) Religiousness, current substance use, and early risk Indicators for substance abuse in nursing students. Journal of Addictions Nursing, 17, 151-158. doi:10.1080/10884600600862103