Actors of Psychoactive Drug Initiation among Adolescents in Yaoundé-Cameroon

Introduction: Actors of psychoactive drug initiation refer to those who introduce others to psychoactive drug use (initiators) and those who are introduced to psychoactive drugs (users). By identifying their features, better prevention and intervention programs can be developed to reduce psychoactive drug use among adolescents. This article describes the role of actors of psychoactive drug initiation among teenagers in secondary schools in Yaoundé (Cameroon). Methodology: A cross sectional study was carried out in twelve secondary schools in Yaoundé from October 2022 to May 2023. Adolescents from Form four to upper sixth, who assented to participate in the study and received parental consent were included. Data were collected in a structured self-reported questionnaire and analyzed using SPSS 23. Quantitative variables were expressed using means, standard deviations, median and interquartile ranges depending on the distribution of data. Qualitative variables were expressed in the form of frequency and percentages. Results: Drug use was more prevalent among male adolescents (55.3%) from nuclear families (91.4%) who received relatively high pocket money. The main sources of drug exposure were non-family members (49.7%), especially friends outside school. The most frequent place of initiation was snack bars (33.1%). Conclusion: The study revealed the importance of the family, friends and leisure places in the initiation process of drug use in teenagers. Based on these results, parents and school authorities should work together to create a safe and supportive environment that fosters communication, education to prevent drug abuse among adolescents in Yaoundé.


Introduction
One of the factors that influences psychoactive drug use among adolescents is the role of actors of initiation [1].These are the people who introduce others to psychoactive drug use (initiators) and those who are introduced to psychoactive drugs (users).
Initiators into substance use are known to be mainly family members and peers [2].Concerning the family members, siblings have been identified as a major influence to drug use initiation and abuse.Similarly, teenagers seem to be very sensitive to peers' opinion and behavior.Thus, perceived peer use of alcohol and marijuana has been associated to the onset of use of those substances in children exposed [3].Although some users reported that their first experience with substances was led by curiosity, it remains a priority to target the features of this group of actors to build up better prevention strategies.
In developed countries, despite the high rate of "zero tolerance" preventive interventions initiation of substance use is a common phenomenon in older adolescents regardless of race and culture [1].Nevertheless, the occurrence of early initiation has been reported worldwide.It concerned adolescents experiencing substance use for their first time between 13 to 14 years old.Most of them came from families with poor cohesion and parental monitoring [1].They usually started with alcohol, tobacco and marijuana and were more at risk of polysubstance use.Early initiation has also been associated with greater risk of negative psychosocial, educational and mental health outcomes.This urged the need for earlier intervention for elementary-school-age children including parental training.
Understanding the characteristics of these actors can help design effective prevention and strategies to reduce psychoactive drug use among adolescents.This article aims to explore the actors of psychoactive drug initiation in secondary schools in Yaoundé.

Study Location
The study was conducted in Yaoundé, the capital city of Cameroon.It is the second most populous city in the country with a population of approximately 2.8 million spread over 7 subdivisions.It is an administrative area with a high level of urbanization, industrialization and education.Owing to this high-profile structure, Yaoundé has a higher cost of living than majority of other cities in Cameroon.This creates a favorable environment for drug distribution and consumption.The school system consists of 2 broad categories based on the type of funding: public schools (government funding) and private schools (fee-paying).

Study Design, Population and Sampling
A cross-sectional study was conducted in 12 secondary schools (6 public and 6 private schools) in Yaoundé between October 2022 and May 2023 (8 months).This study builds on previous studies on adolescent psychoactive drug use in Cameroon in terms of its methodological approach.A probabilistic sampling method was used as opposed to a non-probabilistic sampling methods employed in other studies.
Selection of participants was done using a three-stage sampling approach.Firstly, six out of seven subdivisions were randomly selected.Secondly, secondary schools in the selected subdivisions were stratified into public and private categories, after which we randomly chose one school from each category.Finally, a simple random approach was used to select one classroom from form 4, form 5, lower sixth and upper sixth.The survey form was shared to all adolescents who assented to participate in the study and had received parental consent.Considering the fact that drug use among children is still a taboo in Cameroon, the study was limited to adolescents from form 4, form 5, lower sixth and upper sixth because of administrative restrictions.

Data Collection
Research authorizations was obtained from the regional delegation of secondary education and administrative authorization from principals of the selected secondary schools.Eligible participants were then handed a pretested, structured questionnaire adapted from the Global Assessment Programme (GAP) on Drug Abuse Toolkit Module 3 [2].The questionnaire was piloted on upper sixth students in a secondary school not included in the study in order to ensure reliability and internal validity of questions.
The questionnaire contained two major items.The first item sought to identify the users in terms of age, sex, school, pocket money, toxicological information and relevant family history.The second item assessed initiators features (types and sites).
Of the 1593 students enrolled in this study, 1478 students filled the questionnaire completely and were used for the final analysis.A total of 338 participants had taken a psychoactive drug other than alcohol at least once in their lifetime.

Ethical Considerations
Ethical clearance was obtained from the Institutional Review Board of the Faculty Medicine Biomedical Sciences (reference: 0104/UY1/FMSB/VDRC/DAASR/CSD), University of Yaoundé I. Students were approached and the nature and purpose of the study explained to them collectively.Voluntary participation was ensured by obtaining informed consent from all participants.Anonymity and confidentiality, by identifying each technical sheet with numbers instead of names.All information obtained during the course of this study was used for the sole purpose of the study.The results obtained were used to provide baseline data for early diagnosis and prevention of drug abuse.

Measures and Data Analysis
Each technical sheet was visually checked for obvious errors and inconsistencies.
All the validated questionnaires were coded.Data was entered into an automated data entry form in CSPro.We exported this data into the statistical software IBM SPSS (Statistical Package for Social Sciences) for analysis.Data cleaning was done using consistency and range checks.The categorical variables were expressed in frequency and percentage, and the quantitative variables were expressed using measures of central tendency and dispersion.In cases where variables had missing data, we calculated the rates and frequencies with the available data only.

Results
We carried out a cross sectional study in twelve secondary schools in Yaoundé to describe the actors of psychoactive drug initiation.

Sociodemographic Characteristics of Drug Users
The sociodemographic characteristics of drug users were registered in Table 1 and included sex, age, class, school type and weekly allowance of adolescents.The majority of psychoactive drug users in this study were male (55.3%) giving a Family history was registered in Table 2. Most of the drug users (69.2%) came from nuclear families with siblings (91.4%).The majority of the families in the sample had between 2 and 7 members, accounting for 83.2% of the total.Their parents were mostly educated, with more than half of them having a tertiary degree (56.8% of fathers vs 54.3% of mothers).However, three quarters (76%) of the drug users reported witnessing parental conflicts.
Majority of drug users (34.9%) had no one in their immediate environment who used psychoactive drugs.Amongst those who had models of psychoactive drug use, 32.2% of models were friends.Most drug users (84.9%) lived or schooled close to a bar or market.Drug users knew an area in their neighborhood where psychoactive drugs were sold in 42.3% of cases (Table 3).

Initiators and Sites of Drug Use
As shown in Table 4, nearly half of the drug users (49.7%) were first exposed to psychoactive drugs by non-family members, such as friends outside school (47.6%) and schoolmates (42.9%).However, more than a quarter of respondents (25.7%) did not identify any person who initiated them into drug use.Data in Table 5 revealed that the majority of respondents (68.4%) first tried drugs away from their homes (20.4%) or schools (11.2%), with snack bars being the most frequent place of initiation (33.1%).The majority of the respondents (84.9%) lived or studied near a bar or market, and almost half of them (42.3%) were aware of a location where psychoactive drugs were sold.

Discussion
This study found that minority (44.7%) of psychoactive drug users were female, which agrees with what Ogunsola et al. reported among secondary school students in Nigeria [4].The lower proportion of female drug users may reflect the social stigma attached to psychoactive drug use among women when compared to men.
The parents of most drug users had attained tertiary education.This result may be related to the differences in parental availability, interaction, and supervision among different socioeconomic and occupational groups [3].Parents with high-level occupations may have less time and emotional resources to spend with their adolescents and monitor their activities and time use effectively.Moreover, a high proportion of users had witnessed family violence.This finding is in line with the data collected in Central America youth where witnessing violence was associated to an increased risk of adolescent drug abuse [5].The study also found that the environmental factors influenced the students' drug use.Most of the students resided or schooled in areas where bars or markets were present, and nearly half of them knew places where they could buy psychoactive drugs.These results suggest that the students had easy access to drugs and were exposed to drug-related activities in their surroundings.This is consistent with the previous finding that most of the students initiated drug use with non-family members, such as friends or classmates, in snack bars.Metuge et al. reported similar results among university students in Buea [6].These findings may reflect the fact that the students spent most of their time away from home and were more vulnerable to peer pressure and drug temptation.
Most participants started using psychoactive drugs in places other than their homes and schools.Youth can be exposed to psychoactive drugs through various sources, such as peers, family members, and drug dealers.According to a UNODC handbook on youth participation in drug prevention work [7], peers are one of the most influential factors on youth drug use.A large proportion of participants were introduced to psychoactive drugs in snack bars (33.1%).This may be due to the poor regulation and enforcement of some illicit drugs, such as shisha, and the failure of age verification policies for licit drugs.

Conclusion
The study revealed that drug use was more prevalent among male adolescents from educated and nuclear families, who received relatively high pocket money.The main sources of drug exposure were non-family members, especially friends outside school.The most frequent place for drug initiation was snack bars.The findings suggest that drug use is influenced by social and environmental factors, such as peer pressure, availability of drugs, and proximity to places where drugs are sold or consumed.Therefore, preventive interventions should target these factors and raise awareness among adolescents and their families about the risks and consequences of drug use.

Table 1 .
Sociodemographic characteristics of drug users.

Table 2 .
Relevant family history of psychoactive drug users.

Table 3 .
Toxicological characteristics of drugs users.

Table 5 .
Sites of drug initiation.