| ObjectiveBasing on the data about illegal drug use behaviors and regarding risk facotors from the adolescents in Wuhan, China, the study aimed at:①to describe the epidemiological characteristics of illegal drug use among Wuhan adolescents,②to study systematically the risk factors of drug abuse,③to construct the structural equation model on adolescent drug abuse,④to estabolish school-based preventive intervention model on drug abuse,⑤to make the intervention materials and protocol,⑥to conduct intervention on 7th grade school students using our designed intervention program and evaluate effect of the program.The purpose is to supply guide on prevention of drug abuse among schools in the future.Methods1. Epidemiology of illegal drug use and its risk model among Wuhan dolescents.With stratified randomly group sampling, 3018 students (46.9% boys) from fifteen middle schools, high schools, vocational high schools and one municipal-owned university in Wuhan completed paper-and-pencil questionnaires. The survey is anonymous and voluntary. The questionnaire covered demological characteristics, use of heroin, cocaine, marijuana, methamphetamine (ice), MDMA, ketamine, and risk factors regarding drug use. The frequency, means, standard deviant, figures and tables were used for description of drug use behaviors, the GLM was used for the adjustment of gender. Correlation analysis was use for the Cronbachαcoefficients. Explanatory Factor Analysis (EFA) was used for determine the dimensions of the seven constructs measuring drug abuse behaviors and its risk factors. Confirmatory Factor Analysis (CFA) was use to assess the adequacy of the proposed factor structure (measurement model) and the relationships among the latent and manifest variables, and to confirm the measurement model. Structural Equation Model (SEM) was used to compare and modify a proposed hypothetical model with a set of actual data. Data were manually entered into computer with 100% double-entry for quality control purpose with EPIDATA 3.0. All statistical analyses were conducted on personal computer using the software SAS9.0 and SPSS10.0.2. Preventive intervention model on adolescent drug abuse behaviors and evaluation on intervention effectsThe participants included 593 7th graders from 4 schools with median educational level, which locates four administral districts in urban area of Wuhan. The invention was conducted among these four schools with"Cognition-Motivation-Equotion intelligent, CMER"mocel. The intervention totally had seven sessions with 40-minute class time and the sessions were delivered class by class between November and December in 2006. Three months after intervention, the evaluation survey was conducted for comparison in some variables such as drug abuse behaviors, refusal efficacy, curiosity on drugs between pre-intervention and post-intervention. Generalized Estimation Equation (Gee model) was used for evaluating the factors influencing intervention effects.Results1. Adolescent illegal drug use by gender, age and school type.The prevalence rate of drug use among Wuhan adolescents is 3.58%. The rate was 5.37% for boys and 2.00% for girls, and 2.27% for middle schools students, 3.07% for high school students, 8.28% for vocational school students, 3.25% for college students. In the secondary school stage, the prevalent rate increased by grades with the rate of 1.6%, 2.98%, 3.12%, 5.87% for 7th graders, 8th graders, 10th graders and 11th graders respectively. The use rate for college students was 3.25%, which was higher than that for 10th graders.Among 108 drug users, 66 students (61.1%) reported ever to use two and over drugs with 49 boys and 17 girls.2. Adolescent use of any drugsThe prevalent rates for MDMA, heroin, ice, ketamine, cocaine and marijuana were 2.82%, 1.23%, 1.36%, 2.42%, 1.62% and 1.42% respectively. And the use rates of these six illegal drugs were 4.17%, 2.12%, 2.40%, 3.68%, 2.83% and 2.48% for boys, 1.63%, 0.44%, 1.31%, 0.56% and 0.50% for girls respectively. During secondary middle stage, the rates of MDMA and ketamine risen with grade, especially for boys. And for the college students, the rate was close to that for 8th graders. MDMA and ketamine were two most common used drugs among high schools, vocational schools, and college students, with 2.59% and 2.26% for high school students, 6.49% and 5.15% for vocational school students, 2.53% and 2.53% for college students. The rate for other four drugs ranged from 1%~2%.3. Suceptible to drugs Among 3018 students, 10.7% was susceptible to drugs with 13.6% for boys and 8.2%for girls. Susceptible rates were 8.1%, 6.9%, 23.5% and 17.3% for middle schools, high schools, vocational schools and college school students respectively, and 5.2%, 11.3%, 6.2%, 7.5%, 19.1%, 29.5% for 7th graders, 8th graders, 10th graders, 11th gaders and college students respectively. It shows that the rate of vocational school students ranked the first, and the rate for 8th graders increased two times as the same as that for 7th graders.The susceptibility to different drugs is different. The susceptible rate was higher to MDMA (9.3%) and ketamine (7.9%) than to heroin (5.4%), ice (5.4%), cocaine (6.2%), marijuana (5.6%). The rates for six drugs increased with ages firstly and then had a short drop between 15 and 16 years, after 19 years, it began increasing again. But for the MDMA and ketamine, there were not obvious drop. 4. Other characteristics regarding drug useRegarding the recognition of illegal drugs, the students who did not know MDMA, heroin, ice, ketamine, cocaine and marijuana covered 6.6%, 2.3%, 4.4%, 14.4%, 12.1%, 5.7% respectively. The rates who did not know the addiction of MDMA, heroin, ice, ketamine, cocaine and marijuana were 17.7%, 2.7%, 5.8%, 13.2%, 8.2%, 4.9% respectively. The rates who thought no matter to trial once or twice of MDMA, heroin, ice, ketamine, cocaine and marijuana were 25.4%,3.4%,4.0%,15.1%,6.5%,5.5% respectively. The rates who though it easy to quit from MDMA, heroin, ice, ketamine, cocaine and marijuana use were 13.1%, 4.8%, 5.8%, 9.4%, 6.9% and 6.4% respectively.15.8% students was curious of illegal drugs, 14%~18% was not hate, digust of or fear about these drugs, 42.3% students thought it was easy to get the drugs, 5.2% reported that someone ever supplied them drugs in the past year, 24.0% thought their classmates ever used drugs. All of these five rates were higher for boys than for girls, for vocational school students than for other tyes of schools. Especially for MDMA and ketamine, it increased quickly from 7th graders to 8th graders. 82.8 percent showed that they would definitely refuse when their good friends asked them to trial the drugs. But the refusal rate was the lowest among vocational schools, especially to the MDMA and ketamine.5. The risk factor model regarding adolescent drug useThe SEM was used to test the proposed model and got the good fit index. In the SEM model, perceived social norm, positive/negavitve assessment on consequence of drug use, supplied drugs by others, and susceptibility to drugs can predict adolescent drug use behaviors directly or mediated by susceptibility. And the refusal efficacy predicted the drug use behaviors mediated by susceptibility to drug. In addition, positive assessment on consequence of drug use can directly predict perceived social norm.6. Intervention stragety on adolescent drug use and evaluation of intervention effect.Basing on the epideomiological characteristics of adolescent drug use and with the help of some psychological and behavioral theories, the CMER model were designed and regarding materials were made for the prevention purpose by increasing recognition on drugs and behavior skills, decreasing motive of drug use, enforcing refusal efficacy. By comparing with pre-intervention, three months after ending intervention, the susceptibility decreased by 19.2% to heroin/cocaine/ marijuana and 9.5% to ice, but increased by 9.5% and 11.8 to MDMA and ketamine respectively. The curiority rate of these six drugs significantly decreased ranged from 35.7% (MDMA) to 70.9% (marijuana). The refusal rate of drugs had slightly increase (3.5%), mainly on the heroin/cocaine/ marijuana, but the rate slightly decreased on MDMA, ketamine and ice. Except for three items of"for the majority of drug users, doctor is the most important source of drugs","almost everyone will use drug when he/she was very disturbed or unhappy"and"drug use is related with low willpower", the recognition of other items is better than pre-intervention. The cognition on accessibility of drugs, perceived adult drug use increased after post-intervention, but the recognition on perceived parent/friends attitude on their own drug use and perceived peer drug use did not show significant improvement. After intervention, the motives to use drugs siginificantly lowered and self-esteem increased (P<0.05).ConclusionDrugs, especially new types of drugs (named as club drugs) are becoming a serious threat to adolescent. In contrast, the adolescents have relative low recognition and refusal efficacy. A lot of adolescents take the attitude of curiosity and acceptance on illegal drugs, and they are lack of immunology on these substances. The SEM model, basing on the data from 16 schools, can be explained by some psychological and behavioral theories. With the help of the SEM model and regarding theories, we designed school-based CMER preventive intervention program. The program can decrease adolescent curiosity and susceptiblilty to drugs, increase refusal efficacy and have good short prevention effect on drug use. Meanwhile, the program can improve the adolescent recognition on illegal drugs, correct their wrong attitude, decrease motive of drug use. These indicated that our school-based CMER model and intervention protocol, focusing on recognition increase, motive decrease and integration of skills and affection eduction, can prevent adolescents from drug use. It suggests that CMER program have important value to extend in other schools.Innovation1. It is the first time to estabilish the predict model of drug use focusing on Chinese adolescents, by use of psycho-behavioral theories and SEM model.2. It is the first time to establish the school-based CMER prevention program and have got good short intervention effect.3. The intervention materials were designed, which was based on psycho-behavioral theories and aimed to prevent adolescents from initial drug use. The materials include student textbook, teacher guide, multi-media slides and vedio. It got the recognition and reception from students and teachers.
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