1. Introduction

Secondary schools are an important setting for implementation of school based alcohol and drug prevention policies and teachers are valuable assets in the delivery of these initiatives. School based psychoactive substance prevention strategies may however compete with already existing academic agenda. [1-3] There is profound optimism that alcohol and drug education and counselling provided by teachers through educational programmes may delay or prevent initiation of substance use or discourage continuity of use. [4, 5] Although the primary role of teachers is to inculcate skills, impart knowledge and establish sound moral values, they play an invaluable role in school based drug prevention approaches aimed at reducing the willingness to obtain and use alcohol and other drugs, thus limiting the availability and accessibility of licit and illicit drugs within the school environment and also mitigating the harmful health and social consequences of psychoactive substance use. [2]

Secondary school teachers especially in low and middle income countries experience enormous challenges in performing their day to day activities, these challenges include; low remuneration, incessant disruption in academic activities, large numbers of students in class and family pressures. Secondary schools in Nigeria are faced with numerous challenges, some of which are low operational quality, absence of equipment and facilities needed to teach, widespread examination malpractices, lack of parental interests in school activities, high rates of truancy, bullying and school dropout and poor remuneration and conditions of service. [6, 7] As a result of these issues, the psychological wellbeing of teachers may be affected and some might resort to maladaptive coping strategies such as alcohol use. [8]

Studies have reported high prevalence rates of alcohol use among teachers. In 2000, 25% of head teachers in Britain reported heavy alcohol use or dependence on alcohol. [9] In a survey of 500 teachers in Texas, exploring the relationship between work stress, job satisfaction and drug use, it was found that about 50% of teachers sampled frequently use alcohol. These rates were higher than the general population. [10]

Hazardous alcohol use may be defined as pattern of alcohol consumption that intensifies the risk of adverse consequences for the individuals and others. [11, 12] Problematic alcohol use may have several deleterious effects on teachers’ physical and mental health, on the students and on the teachers’ performance in the classroom. Excessive alcohol consumption can lead to dismissal from job or neglect of his responsibilities such as marking examination scripts or attending staff meetings. There may also be frequents altercations with other members of staff in the school. Furthermore, it may lead to poor time management (leading to lateness to class), absenteeism, lack of concentration and limited opportunities for promotion and advancement at work. [8] Students of teachers who indulge in excessive alcohol use may perform poorly academically and develop negative attitude to the teachers with attendant loss of respect and confidence in their tutors. Since teachers are seen as role model by students, the students may imitate their harmful alcohol use and suffer from adverse consequences such as low self- esteem, and become subjects of teachers’ physical and sexual abuse. Prolonged and immoderate alcohol use may lead to “poor decision making in assessing students, planning and delivery of lessons and poor leaning environment”. [8]

The relationship between psychological wellbeing and alcohol use among various occupational groups have been explored, for example, among doctors, [13, 14] lawyers, [15, 16] and nurses, [17, 18] but studies among secondary school teachers have focused largely on psychological distress, burn out and level of job satisfaction among them. [19-21] Alcohol, a widely used and socially acceptable substance in Nigeria may have mental health implications which are important considerations for prevention and treatment. Teachers are held in high esteem in many communities in Sub Saharan Africa, especially if they live in the same environment where they teach. This public scrutiny can be intense and disquiets about confidentiality can impact negatively on the teacher’s need to seek help for alcohol use disorder.

This study seeks to determine the prevalence and pattern of alcohol use among teachers in secondary schools in Abeokuta, South-western Nigeria and identify psychosocial correlates associated with hazardous alcohol consumption among this occupational group with a view to obtaining reliable data for possible intervention purposes.

2. Methods

This is a descriptive cross sectional survey conducted among public secondary school teachers in Ogun state, Southwestern Nigeria. The state has a population of three million seven hundred and twenty eight thousand and ninety eight people (3,728,098) and it’s the 16^th largest state in Nigeria. [22] Abeokuta, the state capital is located about 75 kilometers north of Lagos state, the country’s economic capital. The educational system is made up of primary, secondary and tertiary institutions. Public schools are largely funded by the State government. There are 65 secondary schools with a total population of three thousand five hundred and fifty (3550) teachers. [23]

The sample size was calculated using the formula N=Z²pq/d² and prevalence from a previous study in Nigeria. [24, 25] A multi stage sampling technique was utilized for this study. Ten schools were selected using simple random sampling. Using the list of teachers in each school, three hundred teachers were selected by systematic random sampling. Probability proportional to size was used in this selection, taking into consideration the total numbers of teachers in each school.

Data were collected using a sociodemographic questionnaire, Alcohol Use Disorders Identification Test (AUDIT) and General Health Questionnaire-12 (GHQ-12). The sociodemographic questionnaire was use to obtain information on respondents’ socio-demographic characteristics such as age, gender, marital status, highest level of education, family size and type of religion. Information about length of years in service and salary grade level was also included. The AUDIT was developed by Saunders and colleagues in collaboration with World Health Organization as a simple tool to identify excessive alcohol consumption and assist with management. [26] It can also detect some harmful consequences of problematic alcohol use. [27] The reliability and validity of the AUDIT questionnaire to detect alcohol related problems has been established in Nigeria, and this instrument has been utilized in several studies involving various groups. [14, 27, 28] For the purpose of this study, a cut off score of 5 and above will be used for hazardous alcohol use, while a score of 0 – 4 will be adjudged moderate alcohol use. This is consistent with previous studies in Nigeria that have made use of the same cut off. [13, 14, 28] The GHQ is used to measure current health status and since its development by Goldberg and colleagues in the 1970s, [29] it has been used extensively in different settings and cultures. [30] It was originally developed as a 60-item instrument, but several shortened version are now available. The GHQ-12 was used in this study to assess psychological wellbeing. The scale asks respondents whether they experienced a particular symptom recently, and each item is rated on a 4 point scale (less than usual, no more than usual, rather more than usual and much more than usual). The bimodal scoring method was adopted for this study and a score of 3 and above was taken to indicate psychological distress.

Before commencement of the study, ethical approval was obtained from the Research Ethics committee of the Neuropsychiatric Hospital, Aro, Abeokuta. Permission for the study was given by Ogun State Teaching Service Commission.

The participants completed the questionnaires during their lecture free period after the objectives of the study and sample selection has been explained to them. A written informed consent was obtained, and they were assured of confidentiality of their responses. To ensure anonymity, no identifiable information of respondents such as name and staff number was included in the questionnaire, only serial numbers were used.

Statistical Package for Social Sciences (SPSS) version 22 was utilized for data analysis. [31] Results were presented using descriptive statistics, cross tabulation was performed where necessary, Chi square test and Yates correction were used to show relationship between sociodemographic variables and AUDIT scores. Level of statistical significance was set at p< 0.05. The 95% confidence interval (95%CI) and Odds ratio (OR) were calculated.

3. Results

Two hundred and eighty eight out of the 300 teachers randomly selected for the study, completed and returned their questionnaires. This gives a response rate of 96%. Table 1 shows the sociodemographic characteristics of the teachers. One hundred and two participants were male (35.4%) while 186(64.6%) were females. The mean age (SD) of respondents was 40.6 (±7.3) years. The youngest was 20 years old while the oldest was 57years. Over 9 out of 10 teachers were married, (91.3%); about two-third of them having between 1 and 3 children. The majority of the participants (68.1%) had Higher National Diploma (HND) or Bachelor of Science degree (BSc). The mean length of service in years (SD) is 12.9(±7.2), over half of the respondents (54.2%) were in their first decade of practicing as teachers and 49.7% were junior cadre staff.

The prevalence of alcohol use in the past year was 51.4%. In the past 12 months, 80 (78.4%) male teachers and 68 (36.6%) female teachers drank alcohol. Among drinkers, 90 (60.8%) drank monthly or less. Heavy episodic drinking was reported by 26.7% of the respondents, while 10.4% had a history of alcohol related injury to self or others.

Eighty nine (30.9%) respondents met the criteria for hazardous use of alcohol (AUDIT score ≥ 5). The socio-demographic characteristics of participants associated with hazardous alcohol use is presented in Table 2. Hazardous drinking was associated with older age (χ2 = 4.29, df = 1, P < 0.038), male gender (χ2 = 6.39, df = 1, P < 0.011), lower level of education (χ2 = 9.81, df =2, P = 0.007), and larger family size (χ2 = 6.21, df = 2, P < 0.045). Males were 6 times more likely to engage in hazardous alcohol use than females (OR = 6.39; 95% CL = 0.31 –0.87). No significant associations were found between any other socio-demographic variable and hazardous drinking.

Forty eight (16.7%) teachers had a GHQ score of ≥ 3. They were said to be suffering from a psychological distress. The relationship between alcohol-related problems and psychological distress is shown in Table 3. Alcohol related injury was significantly associated with psychological distress (χ2 = 86.80, df = 1, P < 0.001). Respondents with a history of alcohol-related injury to self or others were about 30 times more likely to have psychological distress (OR = 30.62; 95% CI = 11.95 – 78.49). The relationship between heavy episodic drinking and psychological distress was not statistically significant (OR= 11.16; 95%CI = 0.58-2.29). Although higher proportion of respondents with hazardous alcohol use had psychological distress (22.5% VS 14.1%), this relationship however was not statistically significant.

Table 1. Socio-demographic Profile of Respondents

Table 2. Factors Associated with Hazardous Alcohol Use

Table 3. Association between Hazardous Alcohol Use and Psychological Distress

4. Discussion

This study examined the pattern of alcohol consumption among secondary school teachers and explored factors associated with hazardous alcohol use among this occupational group. The previous year prevalence of alcohol use of 51.4% found in this study is similar to 50% found among teachers in Texas and consistent with 55.4% found among male and 46.1% among female secondary school teachers in Zimbabwe. [10, 32] This prevalence of alcohol use among teachers in Nigeria is two to three times higher than that found among the general population by several studies. For example, a recent nationwide epidemiological survey of substance use found a previous year prevalence of 24.5%, [33] which is in keeping with findings from an earlier study by Gureje and colleagues involving respondents representing 57% of Nigeria’s population which reported a past year prevalence of 14% for alcohol use. [34] A study in United States of America also reported consistently higher rates of alcohol use among teachers than the general national population. [10] Although methodological differences might play a role in these findings, other factors such as stressful work conditions, the enormous task of “educating, socializing, empowering and certifying students” and the less than conducive school environment may influence initiating alcohol use as a coping mechanism by secondary school teachers. [6, 35, 36]

Hazardous alcohol use (using AUDIT score of ≥5) was reported by 30.9% of respondents in this study. This rate is higher than the general population prevalence rate for heavy alcohol use of 9% and 3% among males and females respectively in Nigeria reported by Chisholm and colleagues in 2004. [37] However, the prevalence rate for hazardous alcohol consumption in our study is in keeping with the report that nearly 25% of head teachers in schools in Britain reported heavy alcohol use or have alcohol dependence. [9] The level of alcohol use reported by teachers who participated in this study is much higher than that found among some other occupational groups in Nigeria and other countries. For instance, Issa et al and Obadeyi et al reported that 4% and 7% of doctors respectively in Nigerian tertiary hospitals use alcohol hazardously. [13, 14] Furthermore, Joos and colleagues reported that 18.5% of doctors in Belgium are problematic alcohol users. [38] Additionally, the rate of hazardous alcohol consumption among lawyers in Canada is between 15 – 24%. [39] Although sociocultural and individual biological factors may play a role in the varying prevalence, differences in the study population, instruments and factors relating to the various occupations may also be implicate. According to the United Nations Office of Drugs and Crime, [2] teachers play a significant and central role in school-based educational programs aimed at preventing alcohol and drug abuse. Our finding that about one in three teachers have problematic alcohol use draws attention to the urgent need for intervention among this occupation group if the purpose of achieving alcohol and drug abuse prevention in schools is to be realized. This may also have policy implications. Training teachers about adverse consequences of psychoactive substance abuse and their potential roles and impact on school oriented drug misuse prevention strategies may significantly influence their level of alcohol use. Policies incorporating formal drug education into teaching training curriculum may be a step in the right direction.

This study found a significant association between hazardous alcohol consumption and younger age (persons younger than 40years). This is in agreement with several studies conducted in Nigeria among semirural community, [40] in urban settings, [41] and in other countries, [42] that harmful use of alcohol was significantly associated with younger age group. A number of studies on alcohol and drug use within and outside Nigeria have found that alcohol use commonly starts in early adolescents, progresses into young adulthood and gradually decline in the 5^th and 6^th decades of life. [34, 43-46] This pattern is consistent with the “maturing out” phenomenon. [46]

In line with previous studies conducted in Nigeria and other countries, hazardous alcohol use was significantly associated with male gender. [34, 40] Male teachers were 6 times more likely to consume alcohol hazardously. Another study among teachers in similar settings also found a significant association between alcohol consumption and male gender. [31] Psychoactive substance use appears to be a male dominated activity, as men are more likely than women in almost all cultures and societies to use licit and illicit substances, although the gap seems to be narrowing. [47-49] In United States and England, men are twice likely to have alcohol and drug use disorders, and are four times more likely to suffer from alcohol use disorders in Asia. [48, 49]

In our study, we found a significant association between lower level of education and hazardous alcohol consumption. Conflicting findings have been reported between respondents’ levels of education and hazardous alcohol use. Some studies reporting significant association between problematic alcohol use and higher levels of education while others reported the converse. [28, 34, 40, 50]. Lower levels of education may be related to lower socioeconomic status, and it has been shown consistently that alcohol related problems and alcohol dependence are higher among individuals with lower economic status. [51-54]

Five in six (83.3%) teachers reported having positive psychological wellbeing. There was significant relationship between alcohol-related injury and psychological distress, with respondents having a history of alcohol related injury 30 times more likely to have psychological distress. This prevalence is similar to that of 84.5% reported by Babalola & Odusanya among nurses in southwestern Nigeria. [55] Other studies among secondary school teachers within and outside Nigeria reported much higher rates of psychological distress. For instance, Okwaraji and Aguwa [56] found that 32.9% of respondents in their study had psychological distress, while another survey in Nigeria [57] reported 33% of teachers interviewed had psychological distress. A survey of 808 secondary school teachers in Brazil and found the prevalence of psychological distress to be 55.6%. [58] In Japan, 48% of male teachers and 58% of female teachers reported psychological distress. [59] These differences may be due to methodological variations and type of instruments used. Some aspects of secondary school teachers’ responsibilities may engender stress. These include standing for lengthy hours while teaching, assessing and evaluating students work, pressure to prepare lesson notes and complete curriculum, preparation for teaching and delivering lectures. [60, 61] Resorting to hazardous alcohol consumption may be one of the coping strategies for the psychological distress. [8, 31]

There are two important limitations to this study. One, this study was conducted among secondary school teachers in Southwestern Nigeria. There are five other geopolitical zones in Nigeria with diverse cultural and ethno-political structures. These variations will make it difficult to generalize the findings of this study to all secondary school teachers in Nigeria. Two, due to the cross sectional design of our study, a causal relationship between socio-demographic factors and hazardous alcohol use cannot be established. This study utilized a standardized, international recognized and accepted instruments which makes it easier to compare our findings with that of studies conducted in various settings in other regions of the world. The results from this study also add to extant literature on drug use among this occupational group especially in resource constrained settings where there is paucity of studies.

5. Conclusions

In our study, over half of all respondents reported past year alcohol use. About one in three of these secondary school teachers have hazardous alcohol drinking pattern. Male gender, younger age, lower level of education and large family size are significant socio-demographic characteristics associated with hazardous alcohol consumption. Levels of psychological stress among these teachers play a significant role in alcohol related problems. There is an urgent need to address the enormity of problematic alcohol use among secondary school teachers considering the important role they play in school based drug abuse prevention strategies. In addition, further longitudinal research among carefully selected cohorts with some of the risk factors highlighted in this study will assist greatly in determining relationship between hazardous alcohol use and respondents psychological wellbeing.