American Journal of Nursing Research, 2018, Vol. 6, No.

5, 299-308
Available online at http://pubs.sciepub.com/ajnr/6/5/12
©Science and Education Publishing
DOI:10.12691/ajnr-6-5-12

Substance Abuse as Perceived by Adolescents:

A Preventive Approach for Their Safety
Samia A. EL Nagar1,3, Warda El shahat Hamed2,3,*
1
Paediatric Nursing, El-Menoufya University, Egypt
2
Psychiatric and Mental Health Nursing, Mansoura University, Egypt
3
Jazan University, KSA
*Corresponding author: [email protected]

Abstract Substance abuse may lead to criminal behaviors. Substance abuse has major impact on individuals,
families and communities, as its effects are cumulative, contributing to costely, social, physical and mental health
problems. Aim of the study: This study aims to examine effect of health and psycho education on the adolescents’
knowledge, attitude and perception regarding substance abuse. Design: A quasi experimental design was used to
conduct this study. Tool of data collection: Data collection was carried out by using the following tools: An
interview questionnaire form that covers two parts. Part I: Demographic characteristics such as: age, father and
mother’s education, parents’ job etc… Part II: It comprised 54 items: four items sought information about
respondents' level of knowledge and awareness of, and personal familiarity with, illegal drugs; 35 items explored
perceptions, attitudes and beliefs about drug use, drug users and drug-related issues plus 15 items elicited
socio-demographic data including the respondents' age, marital status etc. Results: There is statistically significant
improvement in the level of knowledge after intervention, with p=0.000.Adolescents positive attitude toward addicts
has increased post intervention representing 45.8% of the sample compared with 32.6% pre intervention. Moreover,
the positive perception of the adolescents regarding addiction has increased representing 28.3% post intervention
compared to 3.3% pre intervention. Conclusion: Adolescents have poor knowledge, poor attitude and poor
perception regarding substance abuse. Intervention including health and psychoeducation has an effective result on
students knowledge, attitude, and perceptrion of substance abuse. Recommendations: Frequent assessments of
adolescents knowledge, attitude and perception regarding substance abuse. Assessing sources of students
information and providing frequent educational program for adolecents regarding substance abuse among Egyptian
schools. Collaboration of Ministry of Health with Ministry of Information in providing intervention programs
targeting adolescents and school students for prevention of substance abuse.
Keywords: substance abuse, adolescents, preventive approach, psycho education
Cite This Article: Samia A. EL Nagar, and Warda El shahat Hamed, “Substance Abuse as Perceived by
Adolescents: A Preventive Approach for Their Safety.” American Journal of Nursing Research, vol. 6, no. 5
(2018): 299-308. doi: 10.12691/ajnr-6-5-12.

possible physical, social, and psychological harm, use of

some drugs may also lead to criminal behaviors. Substance
1. Introduction abuse has major impact on individuals, families and
communities, as its affects are cumulative, contributing to
Adolescence is a critical stage in the life-course and can costly, social, physical and mental health problems [1,3].
be considered the most transformative period in the Leitner et al. (1993), in their study of the drug-related
individual’s life. Substance use is a public health problem views and habits of the general public in Britain, found
among teenagers and young adults. Identifying risk and that those substances cited by respondents as being most
protective factors from the perceptions of adolescents can harmful were those which had been the focus of greatest
help setting up effective, culturally sensitive strategies for political and media attention, namely heroin, cocaine,
primary prevention of substance use [1]. The World crack and solvents. Drugs such as cannabis were generally
Health Organization (WHO) defines substance abuse as regarded as less harmful than other drugs including
harmful or dangerous use of psychoactive substances, opiates, barbiturates, tranquillizers, and 'pills', and opiates
including alcohol and illicit drugs. Substance abuse is a were perceived as the most harmful [4]. Drug use can be
public health care problem with global dimension [2]. part of a pattern of risky behavior including unsafe sex,
Widely differing definitions of drug abuse are used in driving while intoxicated or other hazardou, unsupervised
public health, medical and criminal justice contexts. In some activities and in cases when a teen does develop a pattern
cases criminal or anti-social behavior occurs when the person of repeated use, it can pose serious social and health risks
is under the influence of a drug, and long term personality including school failure, impaired memory, problem with
changes in individuals may occur as well. In addition to family and other relationships, loss of interest in normal
 American Journal of Nursing Research 300

healthy activities and risk of contracting infectious diseases million people, corresponding to between 3.5 percent and
like HIV or hepatitis C and mental health problems [3]. 7.0 percent of the world population aged 15-64, had used
Attitude is the belief that represents a psychological an illicit drug - mainly a substance belonging to the
state or feeling which disposes the individual to react or cannabis, opioid, cocaine or amphetamine-type stimulants
respond in a positive or negative manner towards the group – at least once in the previous year [9].
object, situation or individual under consideration [5]. In Egypt’s National Council for Battling Addiction was
many countries substance use is perceived as a moral reported in 2013, the percentage of drug users over the age
problem contributing to family shame and loss of prestige. of 15 had risen from 6.4 to 30 percent since 2011, with
Adolescent perception of drug abuse varies and correlates many users opting for the more accessible drug Tramadol.
with the dominant cultural norms. Adolescents who According to Caritas Egypt, in 2011 Tramadol had the
perceived a strong parental disapproval of drug use were second highest percentage of drug users (36.9 percent)
less likely to abuse drugs. In addition, participation in with the highest percentage of users (38.5 percent) claiming
religious services correlated with less incidence of drug they were addicted to more than one type of drug [9].
abuse among adolescents [2]. Hence it is a must to make a program for enhancing the
Emotional problems and substance abuse are causes for knowledge, perception and attitude of the adolescents toward
dishonor. For adolescents, substance use is a form of substance abuse to prevent the prevalence of abuse among
emotional coping to manage stressors. It is a way to them.
handle the situation and create balance in their life. A
study conducted for incarcerated youth found that anger 1.2. Aim of the Study
expression and avoidant coping was concurrent to
substance use. In addition to that, adolescents who This study aims to examine effect of health and psycho
undergo a traumatic event are more likely to engage in education on the adolescents’ knowledge, attitude and
substance use. It is a self-medicated way to avoid the perception regarding substance abuse, this achived through:
stress and memories of the event [5]. 1. Assessment of adolescents’ knowledge, attitude and
The literature surveyed indicates that knowledge of perception pre intervention.
drugs and perceptions of drug prevalence and the harm 2. Designing and implementing intervention program
associated with drug use tend to be mediated by individual consisting of health and psychoeducation.
experience of drugs, personal acquaintance with drug 3. Evaluating of adolescents’ knowledge, attitude and
users, media coverage of drugs and drug use, and social perception post intervention .
and demographic variables. Attitudes to drugs and drug
use may also depend to some extent on social group
membership and the attitudes held by the social group as a 2. Methodology
whole [6].
Some of the literature on drug misuse suggests that negative 2.1. Design
societal reaction towards drug users may be influenced to
some extent by antidrug media campaigns which typify A quasi experimental design was used to conduct this
drug users as generally helpless and dysfunctional addicts study.
who engage in immoral acts. Among the human groups of
greatest vulnerability for access to the use of psychoactive 2.2. Setting
substances are children and adolescents [7,8].
Drug abuse prevention is a process that attempts to The study was conducted at Talkha technical secondary
prevent the onset of substance use or limit the development schools in Talkha city, Dakahlia governorate, Egypt.
of problem associated wiyh using psychoactives substances.
preventive efforts may focus on the individual and their 2.3. Sampling
family or their surroundings. Prevention programs aim to
educate childrens and adolescents about the harms of A multistage cluster random sampling was used to
substance abuse, allow students to be interactive and learn select a sample of 240 school students. Talka city contain
skills such as how to refuse drugs. Also, teaching youth 1 agriculture secondary school with 200 male students in
and adolescents skills that increase their resistance skills first grade, one commercial secondary school with 108
in social situations may increase protective factors in male students in first grade. In a total of 2 schools and 240
the population. Through careful assessment, identification male students, who agreed to complete the research and
of substance abuse risk factors, and promoting the stayed until finishing the research. 30 students who
enhancement of protective factors of students, both in and included in the pilot study were deleted from the final
out of the school setting, the school nurse can play a vital sample size.
role in the prevention of substance abuse [8]. They having the following inclusion criteria: registered
in the first grade, their age from 16- 17 and willing to
1.1. Importance of the Study participate in the study.

In Egypt, Substance use and abuse have higher lifetime 2.4. Tools for Data Collection
prevalence among young and middle aged males, less
educated persons, working in technical or commercial jobs, Data collection was carried out by using the following
with failed marriage, and living in urban areas. Globally, it tools: An interview questionnaire form that covers two
is estimated that in 2012, between 162 million and 324 parts:
301 American Journal of Nursing Research

Part I: Demographic characteristics such as: residence, 2.7. Field Work

brothers number, sisters number, birth orders, father and
mothers’ education, parents’ job and condition [12,13]. An official letter issued from the Faculty of Nursing,
Part II: It is adopted from tool of Bryan, et al., (2000) Mansoura University was sent to the Ministry of Education
which comprised 54 items: four items sought information and after that the executive of the schools, including the
about respondents' level of knowledge and awareness of, point and time table of the review to get consents to visit
and personal familiarity with, illegal drugs; 35 items schools and direct the review. The health and psycho
explored perceptions, attitudes and beliefs about drug use, education intervention about addiction prevention was
drug users and drug-related issues; plus 15 items elicited created in view of audit of related writing and apparatus
socio-demographic data including the respondents' age, appraisal (pre-test). Time plan was set up and the
gender, marital status, level of education, area of residence, understudies were sorted out into 8 groups (20-30 students).
and employment status [9]. The program was executed in school day beginning from
The modified tool consists of three parts: 9.00 a.m. to 1.00 p.m., and instructive program built
Part A: measures knowledge of the adolescents about included 4 stages:
the drugs and abusers. It consists of 22 items, answers are (1) Preparatory stage: The preliminary stage was done
distributed in a Likert scale ranging from, I don’t know, by utilizing the assessment tools after being revised and
know to some extent, have fair knowledge and have strong tested for general information about substance abuse
background. Score ranged from 1, 2, 3, & 4 respectivly. prevention. Time expended for answering the study sheet
The lower score is 22 and the higher one is 88. ranged from 20-35 minutes. This phase lasted for 3 weeks.
(2) Planning stage: Based on the outcome acquired
Scoring System from the assessment phase, educational sessions were
Higher scores mean having good knowledge and lower created after reviewing of related literature. Detected
score means knowledge deficit. Poor ↓44 (> 50%), Fair needs, requirements and deficiencies in knowledge and
(44 – 66) (50% - 75%), Good (↑66) (<75%). negative attitude and wrong perception regarding
Part B: Consists of 9 statements, it measure attitude addiction and abusers. They were converted into aim and
towards abusers, it consists of 2 reversed items which are objectives of the health and psychoeducational sessions
2 and 8.The higher the score, the greater positive attitude and an illustrated booklet was created by the researchers
of the adolescents toward abuse and abusers. Scores and offered to every member as reference.
ranged from 4, 3, 2, & 1respectively. (3) Implementation stage: The booklet was implemented
in the form of sessions. The length of every session was
Scoring System distinctive according to students' response, time accessible,
Representing positive attitude, neutral attitude, negative and the content of each session. Mostly every session took
attitude, and strongly negative attitude. Negative (↓40%), about 45-60 minutes. They included:
Neutral (40-60%), Positive (↑60%). 1. Health education about type of drugs, their actions,
Part C: Consists of 6 items which measures adolescent’s mode of use, side effects and complications [14,15].
perceptions of seriousness of abuse and abusers. The 2. Psychoeducation about correction of attitudes and
higher score indicates adolescent’s real perception of perception of addiction and this through:
seriousness of the abuse and abusers. Statements 3, 4, 5 A. Consists of two techniques which are: 1. Written
are reversed. Statements are recorded in Likert scale emotional disclosure of students towards abusers as, fear,
ranging from I did not agree, I don’t know, agree, and guilt, sadness etc….. 2. Brain storming about whether the
strongly agree. Score ranged from 4, 3, 2, & 1respectivly. abusers are victims (need help) or devils that need to be
Scoring System avoided [16,17].
Negative (↓40%), Neutral (40-60%), Positive (↑60%). B. Cognitive restructuring of the false perception and
negative attitude towards addicts and addiction, including
2.5. Pilot Study information about hazards of every substance, ways of
addiction, difference between tolerance, addiction, habituation
A pilot study was carried out on 10% of the sample and dependence.
from different schools, to evaluate the clarity and C. Examining inferences about if they are victims who
applicability of the tool and necessary modifications were need help or not, by explaining causes and theories of
done based on their responses. The pilot study was also addiction and applying [18].
used to estimate the time needed to fill in the tool. D. Examining cost benefits of supporting addict persons
Students who participated in the pilot study were later or avoiding them through examining community hazards
excluded from the main study sample. ( through role play) [19].
(4) Evaluation stage: evaluation of the health and
2.6. Validity: psycho educational sessions was done quickly after their
implementation by contrasting the change in students'
The study tools were tested for its content and face level of knowledge, and attitudes and perception through
validity by a jury of five experts in the field of Psychiatry applying the similar apparatuses of pre-test as posttest [14].
and Pediatric Nursing to evaluate items as well as the Ethical considerations: Consent to participate in the
entire instrument as being relevant and appropriate in study was obtained from the parents of school students of
terms of the construct and if the items adequately measure the study group. They were given an opportunity to refuse
all dimensions of the construct. to participate and they were notified that they can
Reliability: chrompach alpha test= 0.8 withdraw at any stage of research without giving any
 American Journal of Nursing Research 302

reason. Also they were assured that, the information given Table 1. Sociodemographic characterstics of technical school
will remain confidential and used for the research purpose students
only. Frequency Percentage
Items
No= 240 %
Residence
2.8. Statistical Design Urban 146 60.8
The calculated data was analyzed and tabulated using Rural 94 39.2
"chi-square" for number and percentage distribution and Total 240 100
correlation coefficient "r" was used; by using SPSS, version Brother number
16.0 to determine if there are statistically significance 1-3 172 71.7
relations. A statistically significant difference was considered 4-6 58 24.1
at p-value p≤0.05, and a highly statistically significant More than 6 10 4.2
difference was considered at p-value p ≤ 0.001. Total 240 100
Sister number
1-3 154 64.1
3. Results 4-6 59 24.6
more than 6 27 11.3
Part I Total 240 100
This Table 1 shows that, most of the sample size is Birth orders
from urban areas representing 60.8% of the population. First 48 20
Most of the study sample has from 1-3 brothers and sisters Second 104 42,5
representing 71.7% and 64.1% respectively. Moreover, Third 64 26.7
more than the third of the sample have a second birth fourth and more 24 10.8
order with a percentage of 42.5%. Total 240 100

90
parent condition
80
70
60
50
40
30
20
10
0
living togather Divorced Separated Father died Mother died

Figure 1. Sociodemographic characteristics of technical school adolescent students’ parents

Figure 2. Figure 3.
303 American Journal of Nursing Research

Figure 4.

Figure 5.

Previous Figure 1, Figure 2, Figure 3 illustrate that more This Figure 5 illustrates that majority of the mothers of
than half of the fathers of the studied adolescent students the study sample are university graduated representing
are working official job, representing 50.4% of the study 32.1% of the sample size.
sample. However, more than half of the studied adolescen
students, their mothers are not working, representing 54.6% of Part II
the study sample. Moreover, more than three quadrant of Table 2: Ilustrates that there is statistically significant
the study sample parents are living together, representing improvements in most of the adolescents’ knowledge after
77.1% of the sample size. implementation of the program.
This Figure 4 illustrates that majority of the fathers of Total knowledge scores of technical school adolescent
the adolescents are secondary graduated representing students related to substance abuse pre and postintervention
25.4% of the sample size.

Figure 6. Figure 7.
 American Journal of Nursing Research 304

These Figure 6, Figure 7 illustrate that, there is addicts, there were highly statistically improvement with
statistically significant improvement in the level of p= 0.000.
knowledge after intervention, with p=0.000. Table 4 illustrated that; There is statistically significant
Table 3 shows that many of adolescents negative improvement in adolescents’ perception towards abuse
attitudes have improved after education, regarding over and abusers. Improvement included perception of using
valuing their problems to get sympathy, seeing addicts as hallucinogens from time to time is not dangerous, using
dangerous person, with p=0.004, 0.006. Regarding living heroin from time to time is not really dangerous and regular
near an addict, and viewing the society as tolerable for use of cannabis is not as dangerous as heroin, with p=0.000.
Table 2. Mean scores of technical school adolescent students’ knowledge about substance abuse pre and post intervention
Pre intervention Post intervention Paired
Domain (No=240) (No=240) t- test P-value
(Mean ±SD) (Mean ±SD)
1 Tea, coffee, and smoking are dangerous as other types of substance abuse 2.8208±.98375 2.9583±.95414 -1.614 .108
2 All illegal drugs are harmful to your health 2.7750±1.07822 2.8500±1.09124 - .733 .464
3 Our society is very tolerant towards drug abusers 2.1292±1.01247 2.0542±1.04360 .795 .427
4 If you tried drugs until once, you became addicted 2.2708±.94492 2.3750±1.11335 -1.181 .239
5 Most young people today use cannabis 2.6417±.91748 2.5857±1.11318 .528 .561
6 Alcohol abuse causes more problems in society than drug abuse. 2.6583±.99367 2.7167±1.13656 -.634 .527
Treatment should be given only to drug addicts who intend to abandon
7 2.6417±1.02108 2.5458±1.08141 .966 .335
addiction
8 Treatment should be available to all drug addicts, according to their need 2.6917±.93554 2.9333±1.11087 -2.791 .006
9 The reason for the drug problem is violent methods with addicts 2.2083±.75319 2.5083±.972319 -4.027 .000
10 Most people are concerned about the drug problem in Egypt 2.0625±.77098 2.2833± 1.11049 -2.501 .013
11 Using hallucinogens from time to time is not really dangerous 1.8851±.86701 1.9489±1.01986 -.730 .466
12 Many drug addicts exaggerate their problems to get sympathy 2.1875±.92967 2.7833±1.07605 -7.284 .000
13 It is normal for young people to try drugs at least once 2.3708±1.95984 2.6917±1.078303 -2.052 .041
14 Drug awareness should begin in primary school 2.8373±2.30396 3.1000±.95418 -1.638 .103
15 Drug-related crime is a major problem in Egypt today 2.4208±.91591 2.8083±1.10757 -4.556 .000
16 Reports of drug abuse among young people are exaggerated by media 2.2125±.99825 2.5083±1.07096 -3.508 .001
Regular use of cannabis is a risk to your health, such as regular use for
17 2.4208±1..05991 2.7875±1.05132 -3.944 .000
heroin
18 Personally I know some who take cannabis. 2.1417±.99198 2.8583±.93106 -8.085 .000
19 I have used one kind of drugs 1.9042±1.02029 2.7250±1.01835 -9.765 .000
20 Personally I know someone who has a / problem with drugs. 2.0250±1.06258 2.8375±1.08751 -8.104 .000
21 Most young people today are taking cannabis. 2.2833±1.02833 2.8500±1.00334 -5.981 .000
22 Alcohol abuse causes more problems in society than drug abuse 2.3417±1.03896 2.6458±1.12204 -3.282 .001

Table 3. Mean scores of technical schools adolescent students’ attitude towards substance abuse pre and post intervention
Pre intervention Post intervention
Paired
Domains (No=240) (No=240) P-value
t- test
(Mean ±SD) (Mean ±SD)
1 It is necessary to be addicted to addict. 2.7583± 0.91474 2.7708±1.21082 -.124 .901
2 Drug addicts do not have a fair chance of progress in society. 2.2667 ±.93050 .3750±1.1575 -1.143 .254
3 People who end up with the drug problem blame only themselves. 2.3792±.8972 2.2083±1.16357 1.830 .069
4 Drug addicts really scare me. 2.7292±1.02152 2.5750±1.10989 1.964 .092
5 Many drug addicts overdo in their problems just to get sympathy. 2.6167±.88846 2.8833± .995225 -2.924 004
6 Almost all drug addicts are dangerous. 2.5667±.95272 2.8083±1.10387 2.798 .006
7 It bothers me to live near someone addicted 2.5083±1.09005 2.9917±1.13886 4.369 .000
8 Our society is very tolerant towards drug abusers. 2.1985±.98481 2.7958±.99580 6.481 .000
9 The man who is abusing me makes me nervous. 2. 4917 ±1. 10151 2.5042±1.17860 .120 .904

Table 4. Mean scores of technical schools students’perception towards substance abuse pre and post intervention
Pre intervention Post intervention
Paired
Domain (No=240) (No=240) P-value
t- test
(Mean ±SD) (Mean ±SD)
1 All drugs are equally dangerous 2.3833±1.03644 2.4167±1.26810 -.320 .749
2 If i tried drugs even once, I was hooked 2.0333 ±.87679 1.9417±1.17716 .965 .336
3 Incidental use of cannabis is not really dangerous. 1.7833±.86498 1.8000 ±1.13962 -.170 .865
4 Using hallucinogens from time to time is not really dangerous 1.7667±.84073 2.4167 ±1.09837 -7.627 .000
5 Use heroin sometimes is not really dangerous. 1.6500 ±.87408 2.6708 ±1.19797 -10.754 .000
6 Regular use of cannabis is not as dangerous to health as heroin. 2.2958 ±.98524 2.9292±1.12372 -6.493 .000
Part III
305 American Journal of Nursing Research

This Table 5 illustrates that fathers’ education is This Table 7 illustrates that adolescents’ fair knowledge
strongly correlated positively with adolescents poor and neutral perceptions are strongly positively correlated
knowledge with p=0.000. Also, positively correlated with with fathers’ job, representing p=0.000. However, adolescents
their neutral perception for addiction. neutral attitude are correlated with their father’s education
This Table 6, reveals to the adolescents fair knowledge, with p=0.05.
neutral attitude and neutral perception are strongly Table 8 shows that, adolescents fair knowledge, neutral
positively correlated with their mothers’ education. perceptions are strongly positively correlated with mothers’
occupation, p=0.000, and 0.003 respectively.
Table 5. Relationship between father's education, Total knowledge scores, attitude and perception of technical schools adolescent students post-
intervention
Father's Education
University Secondary Preparatory Primary Illiterate
No. No. No. No. No. X2 P
% % % % %
(100) (61) (39) (17) (23)
TKS post:
0 0 5 8.2 5 12.8 2 11.8 2 8.7 2.347 .000
Poor
Fair 77 77 43 70.5 30 76.9 13 76.4 17 73.9
Good 23 23 13 21.3 4 10.3 2 11.8 4 17.4
Attitude post
Negative (↓40%) 2 2 4 6.6 3 7.7 2 11.8 2 8.7 1.061 .09
Neutral (40-60%) 36 36 27 44.3 22 56.4 7 41.2 7 30.4
Positive (↑60%) 62 62 30 49.1 14 35.9 8 47 14 60.9
Perception post
Negative (↓40%) 13 13 5 8,2 10 25.6 0 0 2 8.7
Neutral (40-60%) 59 59 36 59 14 35.9 12 70.6 8 34.8 90.116 .000
Positive (↑60%) 28 28 20 32.8 15 38.5 5 29.4 13 56.5

Table 6. Relationship between mother's education, total knowledge score, attitude and perception of technical schools students post
intervention
Mother's Education
University Secondary Preparatory Primary Illiterate
No. No. No. No. No. X2 P
% % % % %
(77) (62) (54) (20) (27)
TKS post:
Poor 4 5.2 5 8 2 3.7 3 15 0 0
Fair 54 70.1 48 77.4 42 77.8 15 75 21 77.8 2.702 .000
Good 19 24.7 9 14.5 10 18.5 2 10 6 22.2
Attitude post
Negative (↓40%) 3 3.9 3 4.8 4 7.4 0 0 1 3.7
Neutral (40-60%) 22 28.6 22 35.5 30 55.6 13 65 12 44.4 1.290 .003
Positive (↑60%) 52 67.5 37 59.7 20 37 7 35 14 51.9
Perception post
Negative (↓40%) 4 5.2 7 11.3 14 25.9 3 15 2 7.4
Neutral (40-60%) 56 72.7 25 40.3 31 57.4 7 35 14 51.9 1.355 0.00
Positive (↑60%) 17 22.1 30 48.4 9 16.7 10 50 11 40.7

Table 7. Relationship between father's occupation, total knowledge score, attitude and perception of technical schools adolescent students post
intervention
Father's Occupation
Farmer Worker Professional Commercial
No. No. No. No. X2 P
% % % %
(21) (91) (121) (7)
TKS post:
Poor 3 14.3 5 5.5 4 3.3 2 28.6
Fair 18 85.7 67 73.6 88 72.7 5 71.4 2.244 .000
Good 0 0 19 20.9 29 24 0
Attitude post
Negative (↓40%) 1 4.8 3 3.3 8 6.6 1 14.2
Neutral (40-60%) 14 66.6 4 4.4 37 30.6 4 57.1 86.213 .04
Positive (↑60%) 6 28,6 84 92.3 76 62.8 2 28.7
Perception post
Negative (↓40%) 3 14.3 16 17.6 11 9.1 0 0
Neutral (40-60%) 12 57.1 47 51.6 79 65.3 4 57.1 90.622 0.00
Positive (↑60%) 6 28.6 28 30.8 31 25.6 3 42.9
 American Journal of Nursing Research 306

Table 8. Relationship between mother's occupation, total knowledge score, attitude and perception of technical schools adolescent students post
intervention
Working Not Working
No. No. X2 P
% %
(109) (131)
TKS post:
Poor 7 6.4 7 5.3
Fair 82 75.2 98 74.8 71.113 .000
Good 20 18.4 26 19.9
Attitude post
Negative (↓40%) 3 2.8 10 7.6
Neutral (40-60%) 51 46.8 43 32.8 26.933 .2
Positive (↑60%) 55 50.4 78 59.6
Perception post
Negative (↓40%) 19 17.43 11 8.4
Neutral (40-60%) 65 59.63 77 58.8 29.751 .003
Positive (↑60%) 25 22.94 43 32.8

4. Discussion adolescents after intervention than pre. This could be

rationalized as most of our cultures consider coffee, tea
Substance abuse is a major problem in Egypt, due to and even smoking not a form of addiction as their side
rapidly growing and changing patterns of substance use. effects appears on long run. Moreover they consider
This approached as a method of preventing abuse. stopping them is not making withdrawal symptoms as
Part I: Regarding socio demographic data, most of the other drugs [20].
study samples are from urban areas representing about two There were statistically significant improvement in
thirds of the sample. This influenced the knowledge of adolescent knowledge regarding (Alcohol abuse causes
adolescents about abuse and their attitude towards abusers. more problems in society than drug abuse) with p=0.000.
As most of them have a relative, neighbor or even know This agrees with Kerry et al. (2013) who reported
someone who abuse, in contrast to adolescents who live in substantial evidence relating to the positive effects of
rural areas. This agrees with what Hamdi E stated that school-based alcohol education and life-skills programs on
People of rural origins (29.3%) are the least at using school children's alcohol related-knowledge and attitude
substance [20]. [23]. Adolescents knowledge after intervention has
Part II: Regarding adolescents’ knowledge, attitude, improved than pre intervention regarding cannabies
and perception pre and post intervention. Regarding (regular use of cannabies is as risk to your health as heroin)
adolescents knowledge, there were statistically significant (Table 3) with p=0.000. This rationalzed as Cannabis in
improvements in the level of knowledge after Egypt is illegal, but its use is a part of the common culture
implementation of the program in many forms. After in the country for many people [24].
implementation of the program adolescents level of poor Also fair knowledge of the adolescents after counseling
knowledge have decreased about the tenth of their number. could be regarded to strong correlation between mothers’
Moreover, adolescents with good knowledge have level of education (university and secondary educated)
increased about sixth of their number after implementation and adolescents’ knowledge regarding addiction with
of the program. This result could be related to effect of p=0.00. As educated mothers could have more knowledge
comprehensive counseling which included changing than non educated or moderately educated mothers.
concepts related to abuse. The sessions included definition Regarding adolescents’ attitude towards addicts and
of the abuse, tolerance, habituation, and addiction and addiction, there is statistically significant improvement in
difference between them. Description of symptoms, side the adolescents’ attitude regarding believes such as
effects and complication of each type o substance abuse. (Almost all drug addicts are dangerous), (It bothers me to
Hence, adolescents’ knowledge changed about the idea of live near someone addicted), (Our society is very tolerant
“use of analgesics as most of the adolescents don’t towards drug abusers), with p=0.000. Using cognitive
consider them abuse”. This agrees with Haddad et al., who restructuring and examining inferences about if addicts are
found that there is a deficiency in the students’ knowledge victims who need help or not was a helpful method to
and believes regarding addiction. Moreover describing change the attitude of adolescents towards addicts. As
symptoms of addiction has changed their view of people most of adolescents use selective abstraction about any
as they could see before. Describing causes of addiction situation they expose to and make a generalization and
increased their knowledge with addictive behavior. Also, forming an attitude towards the situation or objects they
Hadad et al., stated that nursing intervention helped in exposed to [19]. This result agrees with Pooley etal., who
improving students' knowledge, awareness, and their attitude said that environmental educators interested in changing
toward substance abuse, and abuser [2]. Congruent with environmental attitudes, emotions and beliefs, rather than
what researches said, west encourages us to think knowledge, need to be targeted as sources of information
differently about people and populations with substance on which to base their environmental programs [25].
use problems [22]. Regarding perception of the adolescents on the severity
Considering drinking of tea, coffee, and smoking are of addiction and abusers, it was found that, there is
dangerous, there was no change in the knowledge of the statistically significant improvement in adolescents’ perception
307 American Journal of Nursing Research

towards abuse and abusers. Improvement included perception 6. Recommendations

of using hallucinogens from time to time is not dangerous,
using heroin from time to time is not really dangerous 1. Frequent assessments of adolescents’ knowledge,
and regular use of cannabis is not as dangerous as heroin, attitude and perception regarding substance abuse.
with p=0.000.This explained as an effect to cognitive 2. Assessing sources of students information and
restructuring and role play techniques. This agrees with providing frequent educational program for adolecents
Beck, who said that memory restructuring and role-playing regarding substance abuse among Egyptian schools.
techniques are helpful to elicit effects associated with and 3. Collaboration of ministry of health with ministry of
restructure painful memories of events that shaped information in providing intervention program targeting
unhelpful core beliefs [26]. adolescents and school students for prevention of abuse.
Also the results stated that adolescents’ neutral attitudes
for danger of abuse and abusers are strongly correlated
with mothers’ education with p=0.003. This result References
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