1. Introduction

According to a United Nations Office on Drugs and Crime (UNODC) Report (2005), some 200 million people, or 5 percent of the world’s population aged 15 - 64 have used drugs at least once in the last 12 months – 15 million more than the previous year’s estimate. The passage from high school to college is commonly marked by an increment in frequency of opportunities for peer interaction and in importance of the role of peer norms. Sixty percent of individuals within the 21-25 age groups have reported alcohol consumption 30 days prior to the study while 28% of the group aged 18-25 reported binge drinking in the US [6].

Addictive behavior affecting human health is on the rise in many countries including developing countries especially among young adolescents [6]. Several studies have indicated that cigarette smoking, alcohol consumption and illegal drug use are common among university students [1, 6]. There is a strong link between khat chewing and excessive alcohol consumption, and it is believed to be one of the factors associated with unprotected risky sexual behavior, predisposing the youth for HIV infection and transmission [7]. There are limited studies on substance use and its associated factors amongst different segment of society. In Ethiopia, there areas geographically suitable socially and culturally in consuming different substances. Of the main areas, cities and towns in the eastern corridors in Ethiopia, Jigjiga town is mentionable. This indicates, as substance use among undergraduate students pursuing their education in such geographical pattern warranty study. This study also designed with the intention to fill this knowledge gap.

The use of alcohol, tobacco and other substances constitutes one of the most important risk–taking behaviour among adolescents and young adults in college and University students [1]. Use of these substances has become one of the rising major public health and socio-economic problems worldwide. Recent trends indicate that the use of substances have dramatically increased particularly in developing countries [1]. It is estimated that 9% of the global population aged 12 or older are classified with dependence on psychoactive substances such as alcohol [2].

Tobacco consumption has been the main risk factor for chronic diseases such as cancers, chronic lung disease, diabetes and cardiovascular diseases, however; its use has become a growing concern among college students in many parts of the world [3]. Furthermore, the use of drugs and alcohol among students has become a growing concern [4]. Several studies indicate that substance use among Ethiopian adolescents is considerably rising [5]. Nowadays, alcohol and khat are widely consumed among high school and college students in Ethiopia [5]. Of the young segment of the Ethiopian population, college and university students are the most at risk of using alcohol and other drugs such as khat and tobacco [5].

Most often stimulant medications are increasingly used by high school and college students as a means to improve academic performance. Entering the university, often leads to new opportunities, independence from family control, self-decision making, and peer-pressures to use or abuse alcohol or other drugs. The use of alcohol, khat and tobacco among adolescents can be harmful, leading to decreased academic performance, increased risk of contracting HIV and other sexually transmitted diseases, or other psychiatric disorders such as lethargy, hopelessness and insomnia [2].

2. Objectives of the Study

2.1. General Objective

The objective of this research is to assess the Substance use among undergraduate students of Jigjiga University, eastern Ethiopia: contributing factors and prevalence rates, 2016 with prime focus on khat.

2.2. Specific Objectives

• To assess the magnitude of self-reported khat consumption& other substance use

• To identify associated factors of substance use among Jigjiga University students

3. Methodology

3.1. Study Design

Descriptive cross-sectional study was employed to determine the magnitude and identify associated factors of khat and other substance use among under graduate students of Jigjiga University.

3.2. Study Population

The source population was all under graduate students of Jigjiga University. The study population was under graduate students in the randomly selected departments during the academic year of 2015/2016.

3.3. Sample Size Determination

The required sample size was calculated using Epi info version 3.1 computer statistical software package by considering the single population proportion formula with the assumption of 4% margin of error (d), 95% confidence level (zα/2 = 1.96) and 22% proportion of alcohol consumption taken from study conducted among medical students of AAU.

By using the formula

And using a design effect of 1.5, the calculated sample size with 5% contingency for non-response is 648.

3.4. Sampling Procedures

A multi stage sampling procedure was applied to select sample of undergraduate students in the University (stratification in to colleges, SRS to select departments and stratify the department into batches and finally SRS was employed to recruit the required sample size). There are 8 colleges in the University. The calculated sample size was proportionally allocated to each department based on number of the students.

3.5. Data Collection Procedures

Instrument: Self-administered structured questionnaire was used to collect data on socio-demographic, status of substance abuse and other important data related to the objective of the study. Pre-test was done before the actual data collection started on 5% of the sample size among students who were not participated in the actual study.

Data collection: Data collection facilitators were experienced individuals but not instructors in the same campus and training was given by the principal investigators specially how to create conducive environment for the respondents during data collection, since it is sensitive issue, and how to give clarity, if there is any inconvenience. Following an orientation, respondents was filled the questionnaire in private by arranging their seat far apart from one another and not allowing their teachers to enter the room.

3.6. Data Quality Management

Standard questionnaire was adopted and modified according to the variables included in the study and pre-test was conducted to see, if there is ambiguous question and appropriate corrections were given before the actual data collection time. Data collectors were trained and strict supervision were there during data collection. Data was double entered to check the consistency.

3.7. Data Analysis

Data were entered using epi data 3.1 and export to SPSS version 16 for further analysis. Data cleaning was took place, during data entry by use of double entry and after data entry by simple frequency and cross tabulation and their consistency was checked. After data cleaning complete it will be exported to SPSS version 16 for analysis. Data were analysed through Univariate for frequencies, and percentage; bivariate analysis to see association between dependent and independent variables and logistic regression to see the independent effect of selected variables on the status of substance using odds ratio.

4. Result

4.1. Status of Khat Consumption among Jigjiga University Students

From the total study participants 200 (33.3%) ever chew khat whereas 170 (28.33%) of them were current chewers. About have of them initiated khat chewing during high school, 101 (50.5%) and most of them chew khat at dormitory, 74 (37%). About three forth of them chew with their friends, 147 (73.5%).

Table 1. Khat consumption among regular Jigjiga University students

4.2. Reasons for not Chewing Khat

Participants who don’t chew khat mentioned different reasons for not chewing; among which religious is the dominant one, 302 (75.5%).

Table 2. Reasons for not Chewing Khat among the Study Participants

4.3. Consumption of Drugs among Under Graduate Students of Jigjiga University

The study also revealed as there were more additional drug components consumed by the undergraduate student of Jigjiga University. Different types of drugs found consumed by the students, in which shisha dominated other drug preferences.

From the study we were able to understand that, students year of study, sex, having chewer friend, ever smoke cigarette and ever use any drug were significantly associated to chewing khat.

Table 3. Consumption of drugs among regular Jigjiga University students

5. Discussion

In this study, we assessed the prevalence of and factors associated with chewing khat and use of other drugs among undergraduate students of Jigjiga University, eastern Ethiopia.

As indicated in the introduction of this article, substance use is associated with a range of physical and psychological health problems. Hence this study is deemed important from public health perspective because it documents the magnitude of and factors associated with these important risk factors in a population of young university students.

The prevalence of substance use in their life time identified by this study was 52.5% while current users were 40%. Being in the senior academic year, being male, having a friend who consume substance, and using one substance are of major risk factors for the other.

The finding of this study was also lower than the finding of studies conducted among University and college students at different countries like the result of study conducted in Italy (42.2%) [26], study conducted in South Africa (70%) [11], study conducted in western Kenya (51.9%) [21], in Ginnir town, Bale zone among high school and preparatory students (31.2%) [14], the finding of study conducted in Woreta town, North West Ethiopia among high school adolescents (40.9%) [15], the result of a study conducted in Sothern Ethiopia among Dilla university students (64.7%) [16]. The difference attributed by factors but not necessarily limited to difference in the study areas, availability of the source in the area and the attitude of the local community towards khat chewing and consuming additional drugs following intake of this stimulant leaf and periods of time when the aforementioned studies conducted.

The current prevalence of khat chewing in this study was found to be 33.3%. This result was higher than a similar study conducted among Debra markos Poly technique students in Debra markos town, north Ethiopia (7.8%) [12], study conducted among Rift Valley University students in Bishoftu town (20.7%) [13], among Jima University students, south west Ethiopia (24.2%) [27], among Adigerat University students, northern Ethiopia (6.7%) [17], among Mekele University students, northern Ethiopia (14.8%) [18], among school going students in Eastern Ethioipia (24.2%) [28]. This may be due to the cultural difference in which chewing khat is more or less normative and relatively labelled positive for it has been attached to ways of life society for the sake of respite and joy as one move toward eastern part of the country in which current study was conducted than the fore mentioned areas.

The finding of this study is lower than the result of a study conducted in Ginnir town Bale zone among high school students (48.5%) [14], among Dilla University students, southern Ethiopia (41.8) [16]. Again the observed difference may be contributed by the availability of khat in that area i.e. Bale zone of Oromia region and in southern part of Ethiopia, especially Bale zone of Oromia region is one of the areas in which khat is highly produced and utilized for both consumption and commercial purpose.

The current prevalence of cigarette smoking in this study was 14.5% which was higher than finding of the study conducted among college and University students in Nigeria (4.7%) [10], study conducted among Debre markos poly technique, northern Ethiopia (5.4%) [12], study conducted among Hawassa University students, southern Ethiopia (7.5%) [23], among Adegirat University students, northern Ethiopia (6%) [17], among Makele University students, northern Ethiopia (8.8%) [18] and among high school students in eastern Ethiopia (12.2%) [28].

The finding of current study was lower than other similar studies conducted among college students in Italy (24%) [26], survey conducted among college students in Canada (21.6%) [29], among university students in Beirut, Lebanon (37.2%) [30], among college students in western Kenya (42.8%) [21], Bishoftu town among Rift Valley University students, central Ethiopia (18.3%)[13] and among Dilla University students, southern Ethiopia (19.17%) [16]. About 15% of the study participants ever tried other drugs from which shisha accounts about 57% which is followed by marijuana which is about 40% among participants who responded yes to other substance use in the University.

The finding of this study depicted that the prevalence of the drugs was higher than the results of other studies conducted among college students in Nigeria cocaine (3.5%) [10], among college students in southern Iran, cocaine (2%) [31], and conducted among college students of western Kenya [21].

The finding of this study also revealed that having friend, ever chew khat, ever smoke cigarette, and ever tried any drug were significantly associated with drinking alcohol, AOR=33.25 95% CI=11),100, OR=2.78, 95% CI=1.15,6.83), AOR=4.45, 95% CI=1.04,19.08), 11.55(3.28,40.75), respectively. The finding of our current study also comparable with the finding of the study which was conducted among Addis Ababa University medical students in which those students having a friend who smokes, and having friend who chew khat, AOR=2.47, 3.89, and 15.11 respectively [22].

Chewing Khat was significantly associated with student’s year of study, having chewer friend, ever smoke cigarette and ever tried any drug. Accordingly students at their 3rd year of college study were about 6 times likely to chew khat, AOR=6.24, 95% CI=3.32, 11.74) comparing with their junior but there was no significant association with 4th year and above duration of college study.

Students khat chewing behavior was also significantly associated to having chewer friend, AOR =3.29, 95% CI=2.04, 5.30), ever smoke cigarette, AOR=3.63(95% CI=1.78, 7.34), and ever tried illicit drugs, AOR=4.11(95% CI=1.93, 8.74).

Similarly students who chew khat were about 27 times likely to smoke, AOR 27.23(95% CI=9.47, 78.31) compared with those who didn’t chew khat. Using different drugs was another factor significantly associated with smoking, AOR=30.29(95% CI=11.6978.52).

Using different drugs like shisha, hashish and marijuana were other substances frequently used by University students of study population. Like that of other substances mentioned earlier in this study, using different drugs also significantly associated to students year of study, ever drinking alcohol and ever smoke cigarette. Accordingly those student at their year three of study were about 3 times likely to use drugs compared with those didn’t drink, AOR=3.17(95% CI=1.10, 9.14), and those at 4th year and above were about 9 times likely to use the drugs, AOR=8.60(95% CI=2.32, 31.85). The odds of using drugs was also about 3 times higher among those who drink alcohol, AOR=2.84(1.31, 6.12). The chance of using the drugs was about 27 times higher among smokers, AOR= 27.54(955 CI=12.47, 60.81) compared with those who didn’t smoke cigarette.

6. Conclusions

The objective of our current study was to asses magnitude and factors associated to university students’ substance use. Accordingly the magnitude of the substance use was high among the study participants. Students’ year of study, male sex, having a friend who use the substance especially alcohol, and using one substance was a factor for the other. Besides, the nature of the environment and socialization pattern deep rooted in the community’s shared sentiments is other influencing factor in terms of easily accessibility and mass of fortified groups within the addiction. Khat use among the undergraduate students of Jigjiga University is prevalent with statistical ratio of 33.3%.

The study revealed as students year of study increases there is high probability to engage in use of khats which by default followed by consumption of other drugs including shisha, hashish and marijuana. In all drugs and different substances use, seniority in academics and male social class students involvement is highly associated to one another. When compared with other drugs for associated factors, khat consumption is of the major predisposing factor for shisha use.

ACKNOWLEDGEMENTS

We would like to acknowledge the invaluable support rendered to us by the academic staffs and the students of Jigjiga University who provided us all the potential information for the study.

The entire project modest fund was by the Jigjiga University’s, Directorate of Research, Publication and Technology Transfer and for which the authors are highly indebted. The University’s management support in facilitating realization this endeavoured work is also sincerely appreciable.