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ALCOHOL USE KNOWLEDGE, ATTITUDE AND PRACTICE AMONG SECONDARY SCHOOL STUDENTS
Background to the Study
Alcohol use and associated risk behaviours of secondary school students is a public health concern. Excess intake of alcohol may cause accidents on the roads, homes, and at work places. Heavy drinking is also a major cause of hooliganism, an anti-social behaviours and violence in the homes as well as of the breakdown of personal relationships (Smith & Carol, 1992). The researchers further stated that many people, however drink regularly but never become drunk, violent or argumentative and so assume that their drinking is not harming them. The researcher that regular consumption of substantial quantity of alcohol may damage the liver, the heart and the brain and that if a high alcohol intake is maintained for many years, permanent damage to these organs is inevitable. Different authors have varied definitions of alcohol.
Bevan (1990) stated that alcohol is a social hazard and explained that many eastern countries have banned or restricted the sale of alcohol, while in some countries the use of alcohol has some taxes and levies attached to it thereby making it too expensive for people to buy especially the secondary school students. Equally, in certain societies, the sale of alcohol to persons under a certain age is illegal but drinking alcohol is usually allowed under parental supervision (Pitman & White, 1991). Wagman and Ferguson (1997) defined alcohol as members of class of organic compound of carbon, hydrogen and oxygen. Procter (1999) defined alcohol as a colourless liquid contained in drinks such as beer, wine, spirit among others that can make people drunk. These can be considered as hydroxyl derivatives of hydrocarbon groups. Alcohol is colourless and tasteless liquid which is highly volatile and flammable (Miller, 2004). The author also stated that alcohol is part of our social fabric, that drinking it has been viewed as a source of desirable temporary mood modification and conviviality.
Bervan (1990) explained that alcohol is regarded as a drug with different chemical ingredients that induces euphoria, sedation and intoxication .The author further stated that the occasional use of alcohol is socially acceptable while excessive use of alcoholic beverages is socially irresponsible and legally unacceptable in Australia. Studies conducted in the 1970s on alcohol use in Nigeria focused primarily on the drinking practices of middle-aged and young adult men. In recent years, however, younger, students (that is, students between approximately 12 and 14 years of age who are in the early grades of secondary school) have become more involved in drinking.
Availability of alcohol is one of the factors in under-age drinking, that is the degree of efforts required to obtain alcohol as determined by geographic, economic and social factors. NIAAA, (1994) stated that policy and community strategies have been used to help reduce students access to alcohol and decrease the harmful consequences of established drinking. For instance, raising the minimum legal drinking age in secondary schools to 21, all communities and states in Austria saves estimated 20,000 lives between 1975-2000 and all states now have zero tolerance laws, which set the legal blood alcohol limit for drivers younger than age 21 at 0.00 or 0.02. This policy according to NIAAA has been associated with a 20 per cent decline in the proportion of a single vehicle, nighttime fatal crashes among drivers younger than age 21. Zimbodo (2002) revealed that the legal age for using alcohol is 21 years in most states in America. In Antario, the age is 17years, in Quebec the age is 18 years, in Nigeria there is no stated legal age but alcohol consumption is permitted to individuals at 16-18 years and above. Alcohol consumption may harm the individual’s health even if there is no addiction. Wagman and Ferguson (1997) explained that alcohol is any of the family of organic components containing the atomic group. This group which determines the physical and chemical properties of alcohol is attached to a chain of carbon atoms that also hold hydrogen atoms. The typical ethanol called ethyl alcohol or grain alcohol is a member of a large family of components and it is the only simple one that can be consumed safely within limits. Some of the other members as methanol are highly poisonous. Burns (1998) viewed alcohol as a depressant that means that, it can inhibit some types of natural activities that go on in the body. Onuzulike (2008) added that alcohol is a liquid with an intoxicating element and substance. The author explained that the habit of drinking builds up gradually and with excessive use of alcohol, the drinker soon forms the habit of drinking to a level that he or she prefers drinking to eating his or her food. In this study, alcohol is regarded as a social hazard, a depressant with different chemical ingredients that induces euphoria, sedation and intoxication. Estimate suggests that half of the population over the age of 14 years use alcohol at least weekly (Odejide & Olatawura, 1997). Alcohol utilization is associated with significant levels of harm among secondary school students. It contributes to a range of negative health and social consequences including violence, and high risk of unprotected sexual activities. Reports have it that in 1998 in the Northern part of Nigeria, 71 per cent of alcohol used by 14-17 years old was done at medium or high risk for acute harm. Wagman and Ferguson (1997) stated that alcohol generally may be used in pharmaceuticals and to sterilize hospital equipments. King, Ball & Carol (2003) added that 41 per cent of 14-17 years old female drinkers used alcohol at level of medium to high risk for acute harm to at least once a month.
Wagman and Ferguson (1997) stated that alcohol has three main types which include methyl (methanol) ethanol and propane alcohol Methyl or methanol alcohol is an intoxicating ingredient in fermented liquors. It is a violent poison which causes permanent blindness and death from respiratory failure (Marthin, 2003).
Methanol is used as solvent, as raw materials for the manufacture of formaldehydes and special resins, as special fuel and as cleaning agents. Industrially, alcohol is used as a chemical because it can readily be converted into a large number of other compounds. This is done by a simple chemical reaction to yield products such as fuel and waxes, surface active agents used in detergents, lubricants, emollient and forming agents. Payne and Hahn (1997) described alcohol use in a more general way. Alcohol use in a sense involves either taking alcohol correctly (once in a while) or incorrectly (excessively and regularly, that is undesirable use). The researchers further described alcohol use as the taking of alcohol occasionally or once in a while, that is correct use or proper use and in the right quantity. Incorrect use of alcohol on the other hand refers to more narrowly as alcohol misuse.
Furthermore, Soong (2002) opined that medically, alcohol is used to stimulate the body system to work faster, and its narcotic effects is useful for reducing heart pains. Alcohol is also used as sedatives to relieve depression. Alcohol is recommended in damp and cold climates and as energy booster. Wine and spirit in French life is related to strength, courage, romance, friendship and happiness. Soong further stated that, alcohol has the power to destroy germs, reduced fever, cure cold, improve circulation and nourish the body. Alcohol use in this study refers to the intake of alcoholic substances into the body.
In most situations, secondary school students may misuse, and abuse alcoholic beverages. Alcohol misuse means improper use of alcohol. Payne & Hahn (1997) stated that alcohol is misused when it is used inappropriately and in a large quantity which may significantly increase the risk of hazard to the individual user.
Alcohol can also be abused when the intake or consumption of it at a particular time exceeds a standard drink. A standard drink is a volume of alcoholic beverage containing approximately 18 millimeter of absolute alcohol regardless of the type of beverage such as beer, rum, gin and wine (Burns, 1998).
Payne and Hahn (1997) stressed that when alcohol is used excessively, deliberately and chronically, it is said to be abused. Alcohol is abused when it is used in a manner that can cause damage to a person’s health and makes the user to have impulsive urge to take alcohol until the drinking of alcohol affects his power of judgment and reasoning. Achalu (2004) stated that alcohol abuse occurs when alcohol use is hazardous to health and when it affects the person’s ability to work and relate freely with others. Therefore, the knowledge of the meaning of alcohol, its effects and consequences are very important to every body especially the secondary school students such as those in Owerri North Local Government Area of Imo state where the present study will be carried out.
Knowledge is the sum of what is known. Hornby (2000) stated that knowledge is fact, information, understanding and skills that a person has acquired through experience or education. This definition refers to the acquisition of facts and information and does not indicate the processes of acquisition. Omeregbe (1991) defined knowledge as the facts of understanding events, issues or objects that are acquired either through learning or experience. The researcher further explained that knowledge is broader and comes about as a result of learning via cognitive, affective and psychomotor domains. Omeregbe opined that knowledge could be justified as the most important out come of learning. Learning which results in knowledge can be formal as in the case where students from secondary schools are given health talk about alcohol use, its actions and effects or informal as in a situation where students get information concerning alcohol use from their friends, classmates, prints or electronic media. The researcher further stressed that when students are well informed about the actions, effects and consequences of using alcohol, this will enhance adequate knowledge and development of positive attitude towards alcohol use. Adeleke (1994) stated that knowledge relating to alcohol use can significantly be enhanced through health education. Adeleke identified that lack of knowledge as a diseases in the life of many African communities, especially in rural areas. This factor, Adeleke stated exposed rural dwellers to the scourge of preventable and treatable diseases including alcohol ailments which are consequences of over consumption of alcohol. Akpata (1997) added that knowledge of alcohol seems to be poor among secondary school students in the rural areas. Knowledge of alcohol use in the context of this study means, the understanding or experience students from secondary schools have acquired regarding the meaning of alcohol, effects and its action on the body. Possession of adequate knowledge regarding alcohol use by secondary school students such as those in Owerri North is of the paramount importance. Possession of correct knowledge regarding alcohol use will make them to grow up with correct knowledge of alcohol use and develop positive alcohol attitude and practice. Having correct knowledge of alcohol use can lead to reduction in alcohol related problems or disorders.
Another common concern among secondary school students is their attitude to alcohol use. Attitude refers to people’s affective feelings of likes and dislikes. Attitude emerges out of people’s experience which can be positive or negative. It is positive when a person develops a strong attraction of his likes, situation, object, or other persons or groups. While it is negative when the person develops a strong dislike for situations, objects, persons, groups or other identifiable aspect of our environments. Oserenren (1996) stated that attitude is a mental and natural state of readiness organized through experience, exerting a directive or dynamic influences upon the individual’s responses to all objects, events and situations to which it is related. Anderson (1998) viewed attitude as a moderately intense emotion that predisposes individuals to respond consistently in a favourable or unfavourable manner when confronted with a particular object. The researcher further added that attitude is an important determinant of behaviour which substantially influences one’s reactions in a wide variety of situations. Abanobi (2005) opined that attitude is how reality is perceived by the individual or group. Abanobi also stated that it is learned and that attitude towards an object, group or individual develops with time upon when, where and how it happens. Parks (2007) viewed attitude as acquired characteristics of an individual, which predispose him or her to respond in some preferential manner. Attitude when used in relation to alcohol use is termed alcohol use attitude. Applying this in the present study, alcohol use attitude means the feelings, beliefs and actual action the secondary school students have towards events, situations and issues relating to alcohol use. In this study, alcohol use attitude refers to a feeling, emotion, or thinking that predisposes secondary school students to respond either positively or negatively towards alcohol use, towards people suffering from effects of alcohol and towards people withdrawing from excessive drinking.
Practice refers to a way of doing something regularly. Hornby (2005) defined practice as a systematic repetition of an exercise, performance or behaviour. Relating this to the present study, alcohol use practice refers to a way of using alcohol which could be habitual or systematic as in a situation where one takes alcohol regularly or once he/she feels like taking it.
Secondary school students should be well informed about the dangers of using alcohol. A student according to Hornby (2005) is a person who is studying at a school especially at secondary school. Secondary school students typically range from eleven to about seventeen years in an ideal situation. They consist of junior secondary school one to three (11-14yeras) and senior secondary school one to three (15-17 years). The later groups of students are usually full of youthful exuberance and are under peer group influence. As members of peer group, they like experimenting with a lot of things including taking alcohol. For the purpose of this present study, secondary school students are those persons between the ages of 11-17years who are studying in secondary schools (Nigeria Demographic and Health Survey DHS 1990). It can be agreed that when students in the secondary schools acquired adequate knowledge on alcohol use, its effects and consequences, it will help them to avoid situations which can lead to alcohol ailments
Beckin (1990) stated that consistent consumption of alcohol leads to an inflammation of the stomach accompanied with nausea and loss of appetite. Johnson and Sedlacek (1997) stated that the health effect of alcohol in a person is determined by the blood alcoholic concentration (BAC). Johnson and Sedlacek further stressed that since alcohol is classified as a central nervous depressant; it interferes with or depresses the function of nerves, muscles and many other body tissues with stupor, unconsciousness and even cause death.
Psychologically, alcohol encourages different effects on behaviour and produces a phenomenon known as state dependency, while alcohol makes some people feel relaxed and mildly euphoric, it causes wild agitation, extreme mood swings and violent behaviour in others. Alcohol leads to tolerance (lower sensitivity to alcohol) and increased discomfort. It produces a chronic behavioural disorder popularly known as alcoholism (Marvinga, 1995). Odejide and Olatawura (1997) were of the view that alcoholics are susceptible to heart attacks, ashma, ulcer, cirrhosis of the lever and hypertension and are likelier to die of pneumonia or influenza.
Onuzulike (2008) stated that one of the greatest demerits of alcohol is that it provokes loquaciousness and unexpected change in mood and occasionally uncontrolled emotional displays. The author maintained that alcoholics do not concentrate on their jobs, class activities especially where high level of mental alertness is required. Secondary school students who engage in alcohol perform poorly in their academics and they like breaking school rules and regulations. Onuzulike added that due to their behaviour in addition to poor performance in their academic works, they lose their friends and have poor family relationship. Glassco (1997) stated that social rejection leads the alcoholics to drink more and more, thus adding to their problems. Trumbo (2007) stated that signs and symptoms of alcoholics include: inability to sleep for extended periods of time, social withdrawal, inability to cope with minor problems, aggressiveness, hostility from someone who is usually passive and compliant, dropping out of school and activities and deterioration and abandonment of personal hygiene. If secondary school students possess adequate knowledge on alcohol, it will help them to develop measures for the control and prevention of ailments and effects caused by alcohol.
Wagman and Ferguson (1997) opined that in order to stop the dinking habit, two approaches are adopted. They are gradual withdrawal and alcohol education. Gradual withdrawal means when a person who is dependent on alcohol gradually reduces the quantity he uses or even abstains completely from it. According to Willing and Beckin (1990) those wishing to stop drinking should take time off from drinking and learn to say no when drink is offered to them. Gradual withdrawal is based essentially on modification or complete change in alcohol behaviour. It requires determination and will-power. Alcohol education is the most important approach to the control of alcohol consumption. It will make people aware of the legal, medical and overall consequences of alcohol. Alcohol education should not be limited to students. Working adolescents and those in the rural communities, need as much alcohol education as those in schools and towns. Onuzulike (2008) added that a system of public education methods should be adopted. These include the use of mass media (news papers, radio, television programmes) where experts in alcohol problems discuss them in these media, the setting up of an alcohol education centres to provide education and training, run seminars, conferences and course related to alcohol use.
This present study is anchored on three theories. These theories are: critical knowledge theory, theory of reasoned action and self efficacy theory. Critical knowledge theory approaches knowledge as an on going dialogue (Dignam, 1992). The theory of reasoned action was designed to explain not just health behaviour but also all rational behaviours. While self efficacy theory implies that one is capable of controlling his practice of a particular behavior.
There are some demographic factors that are associated with students’ alcohol use knowledge, attitude and practice. These factors are, gender, class level and location. Gender is one of the factors that are associated with alcohol use. Studies have reported a higher percentage of drinkers among males than among female collegians. Strans and Becon (1993), in their studies reported higher percentage of drinkers among boys than among girls. The same was also found by Rogers (1995) at a mid-western university, and later by Glassco (1997) at a Southern State University. In their studies, they observed that males tend to have a higher percentage of drinking problems than females. In response to the query “Does drinking interfere with school, (ie missing class)”? Fifteen point one per cent of the male drinkers at a western university agreed that it sometimes did, while seven point nine per cent of the females drinkers responded in the same way (Kuder & Madson 2006). When asked do you stop drinking before you get drunk? twenty nine per cent of the female drinkers reported that they always did, while only 19.4 per cent of the males responded in the same way.
Kendal (1990) observed in his study on alcohol and class level that individuals with higher educational status have better opportunities to gaining economic status and consequently the purchasing power of goods and services thus showing that alcohol consumption increases with class level. Banks and Smith (1998) observed that students at a large mid western university drink beer (95%) followed by spirit (90%) and wine (87%).Similarly, in their samples of new England college students, a higher percentage of university students were found to drink more often, to consume more and to experience more drinking problems than college students.
Besides, gender and class level, another variable that seems to be associated with the knowledge, attitude and practice of alcohol use is location. Johnson and sadlaeck(1997) stated that students from rural areas take alcohol at their own apartment or houses while those from urban areas use alcohol most often in restaurants, public places or louges. Walter and Lorch (1998) reported that higher proportion of secondary school students from urban areas use alcohol more frequently than those in the rural areas and therefore experience more drinking problems than students from the rural areas. Following from the above, the need to investigate alcohol use knowledge, attitude and practice among secondary school students can not be over emphasized. This is the basis for the present study in Owerri North Local Government Area of Imo State.
Statement of the Problem
Evidence by smith and carol (1992) revealed that over consumption of alcohol is a major health hazard which adds to many of society’s problems contributing to about one third of road traffic accidents as well as to anti-social behaviour, crime, violence rapes, assault, murder, unprotected sex, suicides, break down of personal relationships and loss of productivity due to alcoholic ailments.
Specifically since 1977 both availability and consumption of alcoholic beverages have increased substantially among young Nigerians particularly, secondary school students between the ages of 11 and 17 years. Odejide and Olatawura (1997) conducted a study of the drinking practices among secondary school students in Ibadan and found out that, the use of alcohol is more prevalent among the age bracket of 11-20 years. Some secondary school students are within that age bracket. Consequently, secondary school students are mostly ignorant of some of the consequences of excessive drinking as most of them go into drinking due to peer pressure, cultism, family problems and act of emulation (Barnes, 1997).
Culturally, Owerri North indigenes where the present study will be carried out are naturally social. They like social gatherings and when such gatherings are made, drinking began. Therefore, the attitude of a particular culture also influence rate of alcohol consumption of the people. The culture of people play a role in the behaviour of people and high rate of drinking are common in cultures that seems to have no standard about how to drink and how much to drink (Helman, 2002).some secondary school student in Owerri North engaged in excessive alcohol intake that is why they always face low academic performances unnecessary rebellion against constituted authority by rioting which some times lead to destruction of school properties or even loss of lives.
There is evidence that alcohol education content is in-corporated into the secondary school health science curriculum (Federal Ministry of education, FMOE 1995), but whether the content is adequately taught to students is another thing. Following from this, it would be reasonable to find out how much knowledge students in Owerri North Local Government have regarding alcohol use, misuse and abuse and their attitude to and practice toward alcohol use.
Purpose of the Study
The purpose of the study is to determine alcohol use knowledge, attitude and practice among secondary school students in Owerri North Local Government Area of Imo State. Specifically, the study seeks to find out the:
- students’ level of knowledge regarding alcohol use , misuse and abuse.
- students’ attitude towards alcohol use, misuse and abuse.
- students’ alcohol use practice, misuse and abuse.
- students’ level of knowledge of alcohol use, misuse and abuse according to gender,
- students’ level of knowledge of alcohol use, misuse and abuse according to location.
- Students’ level of knowledge of alcohol use, misuse and abuse according to class level.
- Students’ attitude towards alcohol use, misuse and abuse according to gender.
- Students’ attitude towards alcohol use, misuse and abuse according to location.
- Students’ attitude towards alcohol use, misuse and abuse according to class level.
- Students’ alcohol use practice, misuse and abuse according to gender.
- Students’ alcohol use practice, misuse and abuse according to location.
- Students’ alcohol use practice, misuse and abuse according to class level.
To guide this present study, the following research questions are posed
- What is the students’ level of knowledge regarding alcohol use , misuse and abuse?
- What is the attitude of students towards alcohol use, misuse and abuse?
- What is the students’ alcohol use practice, misuse and abuse?
- What is the difference in students’ level of knowledge of alcohol use, misuse and abuse according to gender.
- What is the difference in students’ level of knowledge of alcohol use, misuse and abuse according to location.
- What is the students’ level of knowledge of alcohol use, misuse and abuse according to class level.
- What is the difference in students’ attitude towards alcohol use, misuse and abuse according to gender.
- What is the difference in students attitudes towards alcohol use, misuse and abuse according to location.
- What is the difference in students’ attitude towards alcohol use, misuse and abuse according to class level
- What is the difference in students’ alcohol use practice, misuse and abuse according to gender.
- What is the difference in students’ alcohol use practice, misuse and abuse according to location.
- What is the difference in students’ alcohol use practice, misuse and abuse according to class level.
The following hypotheses are postulated and will be tested at .05 level of significance.
- There is no statistically significant difference in the students’ level of knowledge of alcohol use, misuse and abuse according to gender.
- There is no statistically significant difference in the students’ level of knowledge of alcohol use, misuse and abuse according to location.
- There is no statistically significant difference in the knowledge of alcohol use, misuse and abuse according to class level.
- There is no statistically significant difference in the students’ attitude towards alcohol use, misuse and abuse according to gender.
- There is no statistically significant difference in the students’ attitude towards alcohol use, misuse and abuse according to location.
- There is no statistically significant difference in the student’s attitude towards alcohol used, misuse and abuse according to class level.
- There is no statistically significant difference in the students’ practice of alcohol use, misuse and abuse according gender.
- There is no statistically significant difference in the student’s practice of alcohol use, misuse and abuse according to location.
- There is no statistically significant difference in the student’s practice of alcohol use, misuse and abuse according class level.
Significance of the Study
The findings from this study may be of immense benefit to secondary school students in particular and the wider public in general. Specifically, data generated by determining level of knowledge possessed by the students regarding alcohol use, misuse and abuse will help the students, health educators and school authorities. The data may help in exposing the level of knowledge which the students possess in area of alcohol use misuse and abuse. The data will help the health educators and school authorities to know the alcohol education needs of the students as well as help them to design learning experiences on how to avoid the practice of alcohol misuse and alcohol abuse. This will encourage correct alcohol practice and reduce health and social consequences of alcohol misuse and abuse.
The data generated on students attitude toward alcohol use, misuse and abuse will benefit health education teachers, ministries of Health and Education to determine the area students need more information. It will also help curriculum planners to know areas they should lay more emphasis while planning the health education curriculum. It will assist parents and school counselors in determining areas where students need more counseling on alcohol use and alcohol related matters. The data will also help the students to exhibit proper attitude toward alcohol use, misuse and abuse so as to escape from being victims of problems and consequences of alcohol use.
Data will be generated on the proportion of students who posses knowledge of correct alcohol use or who misuse and abuse alcohol. The data will be useful to the health educators, and parent to know the areas to lay emphasis while carrying out alcohol education programmers.
The findings regarding the difference in the students level of knowledge, attitude and practice according to socio demographic variables of gender, location and level of education will be useful to health educators, parents and counselor to determine the group that needs more alcohol education and counseling. The finding will be useful to heath educators, parents and teachers to determine which location needs more health education on alcohol use and alcohol related matters than the other. It will also reveal the proportion of students who practice correct alcohol use and those who misuse and abuse alcohol. It will assist health educators, teachers, parents and the ministry of education to know which gender needs more health education on alcohol use.
The finding will also be useful to students for example, if the students know the health risks involves in alcohol dependence, effects and consequences, they would avoid use of alcohol and practice of alcohol misuse and alcohol abuse.
Finally, the result of the study will help to verify the relevance of some knowledge, attitude and practice theories to alcohol use knowledge, attitude and practice. The critical knowledge theory, theory of reasoned action and self efficacy theory will be adopted.
Scope of the Study
The study will be delimited to all the government owned secondary schools in Owerri North Local Government Area of Imo State. This will cover both co-educational schools and single gender schools that are using the same curriculum. The study will cover the knowledge, attitude and practice of secondary school students on alcohol use, misuse and abuse. The study will also examine factors such as gender, location and class level as they relate to knowledge, attitude and practice of alcohol use among secondary school students.
The study will delimited to only state or government owned secondary schools in Owerri North Local Government Area of Imo State. These schools have homogenous regulations governing them