The association between tobacco smoking and use of other psychoactive substances among Egyptian male students

Drug and Alcohol Dependence, 15 (1985) Elsevier Scientific Publishers Ireland Ltd.

41-56

41

THE ASSOCIATION BETWEEN TOBACCO SMOKING AND USE OF OTHER PSYCHOACTIVE SUBSTANCES AMONG EGYPTIAN MALE STUDENTS

M.I. SOUEIF, Z.A. DARWEESH and H.S. TAHA The National Centre for Social and Criminological Research Embabah,

Cairo (Egypt)

(Received September lOth, 1984)

SUMMARY

The present study is part of a large scale project on the extent of substance use among young people in Egypt. Data collected on two representative samples of secondary school boys (N = 5530) and technical school pupils (N = 3686) through the administration of a standardized questionnaire are broken down along four parameters: tobacco smoking, use of medical psychoactive substances, consumption of natural narcotics and alcohol drinking. In the present paper we concentrate on relevant answers of tobacco smokers vs. non-smokers in both secondary school and technical school students. More smokers than non-smokers were found to be living away from their families and stating that at least one of the parents was dead. More smokers than non-smokers reported participating in peers’ activities. Smokers were, also, found to outnumber non-smokers in being exposed to various kinds of drug-use related stimuli. Invariably, tobacco smokers were found to be more daring than non-smokers in thinking of psychoactive substances, in trying such substances and in continuing to take them. Smokers were, moreover, reported to exceed non-smokers in being under treatment from various physical as well as psychological ailments. These findings were discussed with emphasis on their heuristic value for the development of plans for treatment and/or prevention. Key words: Tobacco students

smoking - Psychoactive

substances

- Egyptian

male

INTRODUCTION

This is the third of a series of reports presenting information on the extent of the use of psychoactive substances among variousgroups of on the Egyptian young people [1,2]. In the first report we concentrated 0376-8116/85/$03.30 o 1985 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland

epidemiology of drug use among male secondary school students. The second report was concerned with the extent of substance use among male technical school students. In both groups the data was collected through the administration of a standardized questionnaire comprising 87 items generating 123 points of query. Estimates of reliability of the items were established and found satisfactory. The tool was also found to be reasonably valid [l]. It will be remembered that the former sample was meant to be representative of male secondary school students in Greater Cairo. It comprised 5530 students derived from 126 classes distributed among 42 schools situated in various districts of Greater Cairo. Subjects’ ages ranged from 15 to 21 years with a modal age of 17 years. On academic proficiency, (measured by total marks obtained on completion of their preparatory education) the pupils were almost normally distributed. The technical school sample consisted of 3686 students derived from all types of technical schools existing in Greater Cairo, including industrial, agricultural, commercial and teachers’ schools. Subjects ranged in age from 15 to 22 years with a modal age of 18 years. On academic achievement they were much poorer than the secondary school group, the majority being lumped towards the lower end of the scale of marks obtained on completion of their preparatory education. Part of our project is to make two kinds of comparisons: (i) Between sets of data collected on each sample, the aim being to uncover meaningful relationships between patterns of drug use and demographic variables, e.g. scholastic proficiency, literacy/illiteracy of parents, socio-ecomomic status of the family, etc. (ii) Between clusters of information gathered on subgroups resulting from the breaking down of each sample along four parameters, viz. tobacco smoking/non-smoking, use/non-use of medical psychoactive substances, use/non-use of natural narcotics and drinking/ non-drinking of alcohol. Through these analyses we intend to shed light on polydrug abuse and on how and why certain aspects of drug use behaviour cluster together. The two levels of analyses, combined together, are expected to provide a wealth of predictors (being correlates) of drug use behaviour, a fact which would, if utilized properly, help planning for treatment and/or prevention of drug dependence. The former type of comparison is being carried out at present and about to be reported. The present paper is concentrated on the elucidation of drug use behaviour of tobacco smokers vs. non-smokers, Other papers will follow, each devoted to the explication of relevant conduct clustering around the remaining three parameters mentioned above. In all cases comparisons will be made within and between the two samples of Cairean studems. FINDINGS

AND DISCUSSION

The questionnaire

items which are closely relevant

to the main question

49

raised in the present study can be classified into five blocks. Following are the areas covered by these queries: (a) family ties; (b) participation in peers activities; (c) exposure to social stimuli related to psychoactive substances; (d) boldness or daringness; and (e) health problems and attitudes towards the present research. In the remaining part of the present article data pertinent to each area will be presented and discussed. It is hoped that these discussions will prove conducive to the emergence of a rather integrated picture that might underline the psychosocial significance of tobacco-smoking by young males, within the universe of the use of psychoactive substances in general.

Family

ties

Three main questions were posed to our testees: one concerning residence with, or away from, the family; another question relating to the father being alive or dead and a third about the mother being alive or dead. Table I presents relevant statistical information. It will be readily seen that percentages of smokers who live away from the family, smokers whose fathers are dead and those whose mothers are dead are always higher than respective percentages of non-smokers. Except for one case, the differences between comparable percentages are invariably statistically significant. A number of comments can be made on this regularity. The simplest explanation, though not necessarily the most valid, is that weakness of family control mechanisms may account for a sizeable part of the variance in tobacco-smoking among school boys. This argument is in line with, and further corroborates, the psychosocial significance of Green’s seventh factor emerging from her factorial analysis of teenagers’ smoking behaviour. Green puts it as follows: ‘Factoring teenagers’ attitude to authority showed smokers are more likely than non-smokers to feel that ‘a teenager should be able to do whatever he wants to do whenever he wants to do it’ [ 31. Another possible explanation would emphasize the role of some feeling of loneliness resulting in the emergence of disturbing mood changes as a reaction to the

TABLE

I

WEAKNESS Question items

Residing with family Father died Mother died

OF TIES IN SMOKERS’ Secondary

school

FAMILIES

students

t

VS. NON-SMOKERS’ Technical

FAMILIES

school

students

Smokers (N = 1173)

Non-smokers (N = 4059)

Smokers (N = 1014)

Non-smokers (N = 2461)

N

%

N

%

N

%

N

%

1101

93.86

3908

96.28

3.61

929

91.62

2317

94.15

2.73

12.11 4.43

421 127

10.37 3.13

1.69 2.16

147 75

14.50 7.40

279 108

11.34 4.39

2.58 3.61

142 52

50

dilution of family ties. In this case tobacco-smoking would seem to be one of a cluster of mechanisms developed to cope with this situation. It should be noted, in passing, that both explanations have room for social learning as a complementary process to shed light on how smoking behaviour, with all its technical details, came to be developed and reinforced. Participation in peers’ activities Three questions tapping this area are included in our questionnaire. The questions and the obtained answers are presented in Table II. Inspection of the table shows that smokers’ share in peers’ activities far exceeds that of non-smokers. In all comparisons (but one, viz. last question in the case of secondary school boys) the discrepancies between relevant percentages reach high statistical significance. Again a number of comments on this finding are invited. First, it might mean that such participation provides the boys with the necessary opportunity to learn more about and to reinforce their smoking behaviour. It can also mean that smoking boys have certain characteristics which press them to flock together in such groupings. Or that they tend to be more extravertive, thus confirming both Eysenck’s [ 41 and Cattell’s [ 51 results concerning a positive association between smoking and extraversion or components of extraversion. Noteworthy is the fact that disparities between smokers and non-smokers are weakest (though still significant) in the case of the last question, concerning having or not having hobbies. Not all hobbies are necessarily practiced in group settings (e.g. cultural hobbies like reading, listening to classical music,

TABLE

II

SMOKERS Question items

Membership of clubs or associations Participation in school extracuricular activities Practicing hobbies

MORE

THAN

Secondary

NON-SMOKERS school

students

PARTICIPATE t

IN PEERS’

Technical

ACTIVITIES

school

students

t

Smokers (N = 1173

Non-smokers (N = 4059)

Smokers (A’= 1014)

Non-smokers (N = 2461)

N

%

N

%

N

%

N

614

52.34

1609

39.64

7.75

408

40.24

607

24.67

9.18

489

41.69

1158

28.53

8.55

457

45.10

740

30.07

8.46

1002

85.42

3358

82.73

2.18

824

81.26

1844

74.93

4.02

%

51

writing poetry and/or short stories, etc.). Indeed, we found that non-smokers exceeded smokers in developing intellectual and some athletic hobbies. Nevertheless, the percentages of smokers entertaining ‘other hobbies’ (i.e. hobbies requiring group activities) far outweigh that of corresponding non-smokers. Exposure to psychosocial stimuli related to drugs Our questionnaire included three groups of items (one group revolving around use of medical psychoactive drugs, another group around natural narcotics and a third concerning alcohol) each defining four positions on a psychosocial continuum of exposure to drug atmosphere. In Table III we present the items and the frequencies of ‘yes’ answers given by our student subjects. The total number of questions is 14 triggering 28 responses (14 from smokers and non-smokers in each sample). Out of these 28 responses we got 26 revealing the fact that smokers who were exposed to relevant drug-related stimuli far outnumbered their counterparts among non-smokers. The statistical significances of the differences were very much higher in 24 cases. Thus, compared with non-smokers, smokers heard more of, saw more of, and had more personal friends and relatives who used mood-modifying substances. Why and how does it happen this way? We have only tentative answers to this question. Presumably, young cigarette smokers prefer social environments which facilitate and fortify their smoking habits. Thus, they would tend to interact more (frequently) with smokers than with non-smokers. Now, it has been shown by many investigators that, among established smokers tobacco usage was significantly correlated with the use of other psychoactive substances [6,7]. ‘Smokers consume more coffee, more alcohol, more psychotropic drugs, more marijuana and more aspirin than do non-smokers’ [8]. In such setting, it is quite reasonable to expect a smoker who is just a beginner to be exposed to all sorts of social stimuli relating to mood-modifying drugs, such stimuli would vary from mere talking about drugs to presentation of behavioural models depicting what it means to be an established smoker. In other words, in making a desicion to establish himself as a cigarette smoker, the schoolboy has to make a complementary one about preferring to interact, more frequently, (and, probably, more intensively) with smokers than with nonsmokers. Once this step is undertaken the remaining part of the story, how to get more exposed to drug-centred stimulation, follows rather automatically. Boldness Fourteen questions eliciting 28 pieces of information are included in our questionnaire to cover the area we call boldness or daringness of the subjects. The questions seek answers pertaining to the student’s personal belief whether taking drugs is useful or harmful. The questions tap, in addition, the following related areas: whether the subject himself ever took any of

THAN

ARE

1065 712 616 265 1056 936 620 197

Heard about narcotics Been show narcotics Friends using narcotics Relatives using narcotics

Heard of alcoholic beverages Been shown such beverages Friends drinking alcohol Relatives drink alcohol

593 469 791 616 523 356

90.03 79.80 52.86 16.80

90.79 60.70 52.52 22.59

50.55 39.98 67.43 52.52 44.59 30.35

3577 2696 1352 447

3474 1151 922 478

2087 1695 2082 819 610 332

88.13 66.42 33.31 11.01

85.59 28.36 22.72 11.78

51.42 41.76 51.29 20.18 15.03 8.18

%

N

%

N

students

TO DRUG-RELATED

Non-smokers (N = 4059)

school

EXPOSED

Smokers (N = 1173)

Secondary

NON-SMOKERS

Heard about tranquilizers Heard about stimulants Heard about hypnotics Been shown the drugs Having friends using drugs Having relatives using drugs

Question

MORE

items

III

SMOKERS

TABLE

1.79 8.76 12.17 5.32

4.63 20.38 19.73 9.35

0.52 1.09 9.79 21.87 21.65 19.79

t

752 637 400 97

782 542 461 222

397 328 638 480 390 277

N

school

74.16 62.82 39.45 9.47

77.12 53.45 45.46 21.89

39.15 32.15 62.92 47.34 38.46 27.32

%

Smokers (iv = 1014)

Technical

STIMULI

1683 1226 522 133

1768 759 577 294

859 747 1021 477 266 210

N

68.39 49.82 21.21 5.40

71.84 30.84 23.45 11.95

34.90 30.35 41.12 19.38 10.81 8.53

%

Non-smokers (N = 2461)

students

3.38 6.99 11.07 4.50

3.20 12.52 12.89 7.50

2.37 1.96 15.52 16.77 18.94 14.50

t

53

the mentioned drugs, whether he continued using such drugs, and, lastly, whether he would consider the possibility, in the future, to use other drugs he did not consume before. Table IV presents relevant data given by smokers vs. non-smokers in both secondary school and technical school samples. It will be readily seen that, invariably, smokers are more daring than nonsmokers, and the differences between comparable percentages are remarkably significant. Thus, tobacco-smoking is strongly associated with believing in the usefulness of taking medical psychotropic drugs, natural narcotics and alcohol. Smoking is also significantly correlated with ‘daring’ to try psychotropic substances, narcotics and alcohol. Moreover, smoking is definitely related to continuing to take such drugs. And, interestingly, there is a conscious readiness in smokers who never tried other psychoactive substances before, to step towards trying these substances if granted the opportunity. The tobacco smoker, thus, presents a well integrated picture (as delineated by his questionnaire answers), where beliefs about, experience with, and a state of readiness for, taking psychoactive substances all converge towards one meaningful direction. It should be noted, however, that we are only presenting a cluster of drug-centred behavioural phenomena. We are not defining cause/effect relationships. Nor are we implying a developmental sequence in time for the emergence of such phenomena. To uncover time relationships among drug-related (behavioural) eve,its prospective studies would be the approach of choice.

Health problems More smokers than non-smokers reported being under treatment (at the time they were examined) for various physical as well as psychiatric ailments. This is congruent with previous reports from other countries [6]. Table V presents relevant data. We tried to go into some details about the kind of physical and psychological complaints featuring among our students. No compelling pattern to distinguish the complaining smokers could be revealed.

Attitudes

towards present

research

Towards the end of the questionnaire, the following two questions were posed to the subjects: (a) If you have anything more to add please write it here; (b) Would you be willing to volunteer for a deeper psychological investigation? A qualitative content analysis of the answers to the former question resulted into a classification of the responses under 7 categories. Examples of these categories are the following: evaluative remarks on the questions included, questioning the utility of the present investigation, asking for more such studies, comments relating to causes of drug abuse, etc. Under almost allthese categories the classified responses given by smokers did not differ significantly from those yielded by non-smokers. On the latter question more smokers than non-smokers among secondary

of drinking beer wine whisky

alcohol

144b

269

153 1500 423 379

85b

41 153 34

306b

336 336

609 586 414

5.63

6.62

3.77 36.96 10.42 9.34

2.18

1.01 3.77 0.84

8.22

8.28 8.28

15.00 14.44 10.20

%

16.53

13.29

6.26 17.31 11.96 17.15

14.68

10.11 29.22 -

8.77

16.18 16.18

13.40 13.29 15.43

54c

257

40 527 133 161

46’

31 311 155

79=

186 186

216 220 200

drugs before. such drugs before. drugs before. such drugs before. and non-smokers were too big to require

19.52 31.03

126a

8.18 65.39 23.96 28.90

229

96 767 281 339

13.55

106a

‘Divided by number of smokers who never took such bDivided by number of non-smokers who never took ‘Divided by number of slrfokers who never took suck dDivided by number of non-smokers who never took eThe differences between the percentages of smokers

Continue drinking alcohol Never drank alcohol I But would drink if granted chance

Ever drank

Belief benefit

5.80 33.33 13.81

68 391 162

18.18

158=

Belief benefit of taking narcotics Ever tried narcotics Continue taking narcotice Never took narcotics 1 But would if granted chance

25.92 25.92

304 304

Ever tried psychotropic drugs Continue taking psychotropic drugs Never took psychotropic drugs i But would take if granted chance

32.40 31.46 28.05

%

calculation

11.16

25.34

3.95 51.97 13.12 15.88

6.54

3.06 30.67 15.28

9.54

18.34 18.34

21.30 21.70 19.72

oft.

4od

218

38 635 90 94

23d

22 93 26

10Bd

191 191

109 145 91

N

2.19

8.86

1.54 25.80 3.65 3.82

0.97

0.89 3.78 1.06

4.76

8.00 8.00

4.43 5.89 3.70

%

Non-smokers (A’= 2461)

students

ITEMS

school

%

N

Technical

RELATED

N

t

DRUG-USE

N

students

REGARDING

Smokers (N = 1014)

school

BOLDNESS

Non-smokers (N = 4059)

Secondary

SHOW

Smokers (N = 1173

NON-SMOKERS

380 369 329

THAN

Belief benefit of taking tranquilizers Belief benefit of taking stimulants Belief benefits of taking hypnotics

items

SMOKERS

MORE

Question

IV

TABLE

8.89

12.88

4.34 14.87 10.40 12.43

19.21

4.75 22.48 -

4.94

9.12 9.12

15.53 13.81 15.50

t

01 Ip

55 TABLE

V

MORE SMOKERS THAN NON-SMOKERS PSYCHIATRIC AILMENTS Question items

Secondary

school

students

COMPLAIN

OF PHYSICAL

Technical

t

school

AS WELL

students

AS

t

Smokers (iv = 1173)

Non-smokers (N = 4059)

Smokers (N = 1014)

Non-smokers (N = 2461)

N

%

N

%

N

%

N

%

Treatment from physical illness

314

26.77

818

20.15

4.85

473

46.65

649

26.37

11.62

Treatment from psychiatric disorder

402

34.27

471

11.60

18.34

357

35.21

308

12.52

15.46

school students (but not among technical school pupils) expressed willingness to volunteer for deeper psychological investigation. We do not think that smokers among secondary school boys were more sick, nor that they were more cooperative, than their counterparts in the technical school sample. It might be rather realistic to consider this disparity between the two samples as a manifestation of the differential ease which they felt towards the accomplishment of a complex verbal task like answering questionnaires similar to the one administered in the present work. CONCLUSION

The limitations of the present study should be underlined. Extrapolations to non-Cairean male students, to other sectors of the Egyptian male population, or to females, should, in the absence of any other systematic information on tobacco-smoking among Egyptian people, be practiced with great caution. More so, when it comes to generalization across national or cultural boundaries. To be sure, universalities do exist in this area of human behaviour. Yet more such empirical studies are needed to permit systematic explicit comparisons. This would be the only legitimate way to transcend what is culturally bound to what is universal. ACKNOWLEDGEMENTS

This study was carried out under the sponsorship of The National Centre for Social and Criminological Research, Cairo. 0. Abou-Sree, K.A. Badr, Gomaa S. Nasr, El-Hussein M.A. El-Sayed and M. Naguib helped in all

56

the stages of getting the data ready for computerization. For the required analyses we used the computer facilities of Cairo University. REFERENCES 1 M.I. Soueif et al., Drug Alcohol Depend., 9 (1982) 15. 2 M.I. Soueif et al., Drug Alcohol Depend., 10 (1982) 321. 3 D.E. Green, Psychological factors in smoking, in: Research on Smoking Behavior, M.E. Jarvik et al. (Eds.), NIDA Research Monograph 17, 1977, Rockvill, MD, U.S.A., pp. 149-155. 4 H.J. Eysenck, J. Psychosom. Res., 7(2) (1963) 107. 5 R.B. Cattell and S. Krug, J. Counsel. Psychol., 14(2) (1967) 116. 6 E.L. Wynder, Interrelationship of smoking to other variables and preventive approaches, in: Research on Smoking Behavior, M.E. Jarvik et al. (Eds.), NIDA Research Monograph 17, Rockville, MD, U.S.A., 1977, 67-97. 7 J.A. O’Donnell, Cigarette smoking as a precursor of illicit drug use, in: Cigarette Smoking as a Dependence Process, N.A. Krasnegor (Ed.), NIDA Research Monograph 23, 1979, Rockville, MD, U.S.A., pp. 30-43. 8 L.T. Kozlowski, Psychological influences on cigarette smoking, in: The Behavioral Aspects of Smoking, N.A. Krasnegor (Ed.), NIDA Research Monograph 26, 1979, Rockville, MD, U.S.A., pp. 97-126.