Keywords
tobacco - alcohol - cannabis - university students - questionnaire - sociodemographic
factors
Introduction
The consumption of tobacco, alcohol, and cannabis is found to be most prevalent among
university students, and this behavior could lead to future social, financial, and
health issues.[1] Tobacco, alcohol, and illegal drug use causes numerous diseases, most of which last
a lifetime.[2] Several studies[3]
[4]
[5] have been published regarding the prevalence of smoking, alcohol consumption and
illicit drug usage among the students, predominately found more commonly among male
students rather than female, although the number of female students partaking in substance
use has recently increased. Undergraduate students who move away from their parent's
house and find themselves having a more independent college life may be influenced
by the university environment.[6] Factors like intense academic pressure, low self-esteem, and living in dormitories
with students they hardly know further increase the risk of substance use.[6]
[7]
When it comes to smoking, there are currently an estimated 1.2 billion active smokers
(29% of the adult population) worldwide. Alcohol use is deemed more alarming, with
nearly two billion alcohol users (48% of the adult population).[8] The global burden of disease attributed to alcohol and illicit drugs is estimated
at 5.4%, while tobacco use is only 3.7%. Globally, the prevalence of alcohol use disorders
is significantly higher than the prevalence of drug use disorders. Worldwide, around
39 deaths per 100,000 inhabitants are attributable to the use of alcohol and illicit
drugs, of which 35 deaths are attributable to the use of alcohol and 4 to the use
of illicit drugs.[9] Europeans suffered proportionately more, but in absolute terms the mortality rate
was greatest in low- and middle-income countries with large populations and where
the quality of data was more limited.[1]
Until recently, no reliable epidemiological data are available on the prevalence of
smoking, alcohol or cannabis use in Kosovar students. A limited number of surveys
with school children[10]
[11] was available, and in 2011 Kosovo also conducted the European School Survey Project
on Alcohol and Other Drugs (ESPAD) on 15 to 16 years old school children,[12] but they have excluded university students and have often not reported at all about
alcohol and cannabis use. In addition, based upon surveillance and monitoring systems
from the Ministry of Health, Institute of Public Health and Psychiatry Clinic, there
is little scientific knowledge about risk factors of substance use among university
students. Their reports or guidelines have given only the prevalence rates of substance
use according to basic demographic variables without controlling for potential confounding
factors.
In Kosovo, affordable alcohol is prohibited for anyone under the age of 18, while
the use of illicit drugs is forbidden by law (Ministry of Health, 2002). However,
young people in Kosovo are exposed to alcohol and other substances and drink more
frequently than adults.[12] These negative influences have an impact not only on health but also on behavior,[13] which lead to poor academic performance and worsened learning skills.[14]
The aim of this study was to assess the sociodemographic factors affecting tobacco,
alcohol, and cannabis consumption among students of different higher education institutions
in Gjilan, Kosovo.
Materials and Methods
Study Design
This was a cross-sectional descriptive study. The study was conducted during the 2019
to 2020 academic year in two universities (public and private) located in Gjilan,
Kosovo.
Participants
The study population comprised of undergraduate students, all studying social science.
The sample was stratified by type of university (public/private). The principal of
each university was contacted and after explaining the nature of the study, their
permission was sought to involve the university in a survey. Once permission was granted,
the university supplied the list of the classes in the faculties and a random sample
containing three classes per year from each school was then selected by the researchers.
Classrooms were randomly selected from each year by using the cluster sampling technique
along with a precise number of students that have been proportionately allocated for
each year and each student was selected through simple random sampling techniques.
Simple random sampling technique was subject in proportion with gender distribution,
class size, and faculty size.
From January to March 2020, a random sample of 507 undergraduates, between the ages
of 18 and 24 (∼16% of the undergraduate student population of 3235) participated in
the survey regarding tobacco, alcohol, and drug inducted behavior, lifestyle, and
college student achievement. The sample size calculation was performed for this study
at the sample size calculator Web site: http://www.raosoft.com/samplesize.html, and, with a 95% confidence interval (CI), 5% margin of error, and 50% proportion
of the total population size of 3235 students, it was calculated that a total of 344
surveys is needed for this research.
This study involved purely voluntary participation. The objectives of the study were
explained to the students and they were informed about their right to refuse without
any negative consequences. We obtained written informed consents from the participants.
Data Collection
This survey was conducted in classrooms through student-completed questionnaires,
under the supervision of the researcher, who explained the purpose of the survey and
highlighted the confidential nature with which the responses would be treated. The
study protocol had been approved by The Ethic Committee of the Faculty of Medicine,
University of Prishtina “Hasan Prishtina,” and is fully compliant with the Helsinki
Declaration's provisions on research involving human participants.
Research Instruments
The research instrument was a self-administered questionnaire with close-ended questions
on the sociodemographic characteristics, and also included questions regarding the
consumption of tobacco, alcohol, and cannabis, developed in Albanian language by the
study researchers based on the literature. The questions intended to find out whether
they have ever tried tobacco or alcohol in their lifetime, whether they have tried
tobacco or alcohol in the previous month and year, as well as how often they smoked
or drank. Additionally, the same types of questions were asked regarding cannabis
consumption. They were close-ended questions and the responses were restructured during
the analysis, so that the logistic regression analysis could be performed. For this
purpose, among the questions related to the frequency of cigarette smoking, alcohol
drinking and cannabis usage, the “never used in a lifetime” answer was coded as “0”
whereas “all other use frequencies (1-50 times and more)” was marked as “1” to conduct
the logistic regression separately as dependent variables. The questionnaire was piloted
among 20 medical students before applying for approval from the Ethical Committee.
The reliability analysis showed a Cronbach's α of 0.911 (n = 507) and an item-total correlation between 0.544 and 0.770.
Selection Criteria
Only full-time students of the selected higher education institutions, irrespective
of their year of study, were enrolled.
Sociodemographic Characteristics
Sociodemographic characteristics included gender (male/female), educational institution
(public/private), living setting (urban/rural), living spaces (alone in apartment,
in dormitory with students, at home with parents), employment (employed, not employed),
marital status (single, engaged, married), monthly family income—which was segmented
into three categories: low (200–399 Euro), middle (400–599 Euro), high (over 600 Euro)—father's
education (primary school, secondary school, university or postgraduate), mother's
education (primary school, secondary school, university or postgraduate), and physical
activity (vigorous, moderate, inactive). Students who regularly exercised, at least
three times a week for more than 1 hour, were considered to be moderately active.
Students who exercised more than the moderate intensity were considered to be vigorous,
and those who exercised less than the moderate intensity were considered inactive.
Statistical Analysis
Continuous variables were reported as mean ± standard deviation (SD) and categorical
variables were reported as frequency (n) and percentages (%). The comparison of the prevalence of tobacco consumption, alcohol
use, and cannabis abuse between public and private educational institution students
was done using Pearson's chi-squared test. Considering the fact that some of the variables
were categorical, regression analysis was utilized in place of partial correlations.
A multivariate logistic regression model was used to evaluate the effect levels after
statistically significant risk factors were discovered in univariate analysis for
tobacco consumption, alcohol use, and cannabis abuse in the past year. To conduct
the analysis, the “Not used in the past 12 months” was coded as “0” in the cigarette
smoking, alcohol use, and cannabis use questions, whereas “Used in the past 12 months”
was marked as “1.” Variables with a p-value less than 0.05 were regarded as independent risk factors in logistic regression
analysis. Each risk factor's odds ratio (OR) and 95% CI were calculated. All data
were analyzed with SPSS v21 (IBM Corp, Armonk, NY, USA). Statistical significance
was set at p-value less than 0.05.
Results
About 56.4% (n = 286) of our participants were female and 43.6% (n = 221) were male. The mean ± SD age was 21.56 ± 1.81 years; 255 participants were
from private institution, and 252 from public institution. The majority of the students
were living in urban areas, were not employed, were engaged, and did moderate physical
activity ([Table 1]).
Table 1
Sociodemographic characteristics of study sample according to type of university
|
Public (n = 252) Mean ± SD or n (%)
|
Private (n = 255) Mean ± SD or n (%)
|
Total
|
|
Mean ± SD or n (%)
|
|
Age (years)
|
21.61 ± 1.83
|
21.51 ± 1.79
|
21.56 ± 1.81
|
|
Gender
|
|
|
|
|
Male
|
106 (42.1)
|
115 (45.1)
|
221 (43.6)
|
|
Female
|
146 (57.9)
|
140 (54.9)
|
286 (56.4)
|
|
Living setting
|
|
|
|
|
Urban
|
246 (97.6)
|
137 (53.7)
|
383 (75.5)
|
|
Rural
|
6 (2.4)
|
118 (46.3)
|
124 (24.5)
|
|
Living spaces
|
|
|
|
|
Alone in apartment
|
8 (3.2)
|
17 (6.7)
|
25 (5.0)
|
|
In dormitory with students
|
194 (77.6)
|
200 (78.7)
|
394 (78.2)
|
|
At home with parents
|
48 (19.2)
|
37 (14.6)
|
85 (16.9)
|
|
Employment
|
|
|
|
|
Employed
|
52 (20.6)
|
49 (19.2)
|
101 (19.9)
|
|
Not employed
|
200 (79.4)
|
206 (80.8)
|
406 (80.1)
|
|
Marital status
|
|
|
|
|
Single
|
95 (37.7)
|
92 (36.1)
|
187 (36.9)
|
|
Engaged
|
136 (54.0)
|
148 (58.0)
|
284 (56.0)
|
|
Married
|
21 (8.3)
|
15 (5.9)
|
36 (7.1)
|
|
Family income
|
|
|
|
|
Low
|
8 (3.2)
|
17 (6.7)
|
25 (4.9)
|
|
Middle
|
196 (77.8)
|
201 (78.8)
|
397 (78.3)
|
|
High
|
48 (19.0)
|
37 (14.5)
|
85 (16.8)
|
|
Fathers' education
|
|
|
|
|
Primary school
|
6 (2.4)
|
7 (2.7)
|
13 (2.6)
|
|
Secondary school
|
113 (44.8)
|
105 (41.2)
|
218 (43.0)
|
|
University or postgraduate
|
133 (52.8)
|
143 (56.1)
|
276 (54.4)
|
|
Mothers' education
|
|
|
|
|
Primary school
|
54 (21.4)
|
49 (19.2)
|
103 (20.3)
|
|
Secondary school
|
196 (77.8)
|
201 (78.8)
|
397 (78.3)
|
|
University or postgraduate
|
2 (0.8)
|
5 (2.0)
|
7 (1.4)
|
|
Physical activity
|
|
|
|
|
Vigorous
|
70 (27.8)
|
70 (27.5)
|
140 (27.6)
|
|
Moderate
|
180 (71.4)
|
181 (71.0)
|
361 (71.2)
|
|
Inactive
|
2 (0.8)
|
4 (1.6)
|
6 (1.2)
|
Abbreviation: SD, standard deviation.
Prevalence of tobacco, alcohol, and cannabis use for lifetime, in the past 1 year/1
month is shown in [Table 2]. Cigarette and alcohol use is highly prevalent among college students, with 66.7%
of students having smoked in their lifetime, 54.2% in the past year, and 44.6% in
the past month, and the majority of students, 54.2% of them, reporting alcohol use
in their lifetime, 46.7% in the past year, and 32.3% in the past month. Cannabis,
while less common, has still been reported to have been used by a substantial proportion
of the students, with 13.8% reporting its use in their lifetime, 10.8% in the past
year, and 8.3% in the past month ([Table 2]). About 46.2% (n = 234) participants were co-users of tobacco smoking and alcohol, and 12.6% (n = 64) were co-users of tobacco smoking, alcohol consumption, and drug use. There
was no statistically significant difference between students from private and public
institutions on lifetime, in the past 12 months, and in the past 1 month on tobacco
smoking, alcohol consumption, and cannabis use (Pearson's chi-squared test, p > 0.05; [Table 2]). [Fig. 1] presents the prevalence of tobacco smoking, alcohol consumption, and cannabis use
over one's lifetime, in the past 1 year/1 month time frame by gender. The prevalence
of tobacco smoking, alcohol consumption, and cannabis use was lower among female students
compared with their male counterparts ([Fig. 1]). There was no statistically significant difference in age between those consuming
tobacco, alcohol, and cannabis use in the past 12 months (p > 0.05; [Table 3].). Analyzed with chi-squared test, the prevalence of tobacco, alcohol, and cannabis
use in the past 12 months period was more prevalent among males (p < 0.05; [Table 3]).
Fig. 1 The prevalence of tobacco smoking, drinking, and cannabis abuse by gender (%).
Table 2
Prevalence of tobacco, alcohol, and cannabis use for lifetime, in the past 12 months
and in the past month according to type of university
|
Lifetime, n (%)
|
Past 12 months, n (%)
|
Past 1 month, n (%)
|
|
Public
|
Private
|
|
Total
|
Public
|
Private
|
|
Total
|
Public
|
Private
|
|
Total
|
|
Tobacco
|
Yes
|
169 (67.1)
|
169 (66.3)
|
X2 = 0. 036
p = 0.85 1
|
338 (66.7)
|
139 (55.2)
|
136 (53.3)
|
X2 = 0. 170
p = 0.68 0
|
275 (54.2)
|
116 (46.0)
|
110 (43.1)
|
X2 = 0. 430
p = 0.51 2
|
226 (44.6)
|
|
No
|
83 (32.9)
|
86 (33.7)
|
169 (33.3)
|
113 (44.8)
|
119 (46.7)
|
232 (45.8)
|
136 (54.0)
|
145 (56.9)
|
281 (55.4)
|
|
Alcohol
|
Yes
|
137 (54.4)
|
138 (54.1)
|
X2 = 0. 003
p = 0.955
|
275 (54.2)
|
127 (50.4)
|
110 (43.1)
|
X2 = 2. 683
p = 0.101
|
237 (46.7)
|
85 (33.7)
|
79 (31.0)
|
X2 = 0. 483
p = 0.508
|
164 (32.3)
|
|
No
|
115 (45.6)
|
117 (45.9)
|
232 (45.8)
|
125 (49.6)
|
145 (56.9)
|
270 (53.3)
|
167 (66.3)
|
176 (69.0)
|
343 (67.7)
|
|
Cannabis
|
Yes
|
32 (12.7)
|
38 (14.9)
|
X2 = 0. 517
p = 0.47 2
|
70 (13.8)
|
24 (9.5)
|
31 (12.2)
|
X2 = 0. 909
p = 0.34 0
|
55 (10.8)
|
19 (7.5)
|
23 (9.0)
|
X2 = 0. 365
p = 0.54 6
|
42 (8.3)
|
|
No
|
220 (87.3)
|
217 (85.1)
|
437 (86.2)
|
228 (90.5)
|
224 (87.8)
|
452 (89.2)
|
233 (92.5)
|
232 (91.0)
|
465 (91.7)
|
Table 3
Tobacco, alcohol, and cannabis use in the past 12 months based on the sociodemographic
characteristics of study sample
|
Tobacco
|
Alcohol
|
Cannabis
|
|
No, n (%)
|
Yes, n (%)
|
p-Value
|
No, n (%)
|
Yes, n (%)
|
p-Value
|
No, n (%)
|
Yes, n (%)
|
p-Value
|
|
Age mean ± SD (years)
|
21.5 ± 1.8
|
21.6 ± 1.8
|
0.699
|
21.6 ± 1.8
|
21.5 ± 1.8
|
0.385
|
21.5 ± 1.8
|
21.9 ± 1.4
|
0.135
|
|
Gender
|
|
|
<0.0001
|
|
|
<0.0001
|
|
|
<0.0001
|
|
Male
|
61 (12.0)
|
160 (31.6)
|
83 (16.4)
|
138 (27.2)
|
179 (35.3)
|
42 (8.3)
|
|
Female
|
171 (33.7)
|
115 (22.7)
|
187 (36.9)
|
99 (19.5)
|
273 (53.8)
|
13 (2.6)
|
|
Living setting
|
|
|
0.878
|
|
|
0.007
|
|
|
0.065
|
|
Urban
|
176 (34.7)
|
207 (40.8)
|
191 (37.7)
|
192 (37.9)
|
347 (68.4)
|
36 (7.1)
|
|
Rural
|
56 (11.0)
|
68 (13.4)
|
79 (15.6)
|
45 (8.9)
|
105 (20.7)
|
19 (3.7)
|
|
Living spaces
|
|
|
0.018
|
|
|
0.001
|
|
|
0.003
|
|
Alone in apartment
|
5 (1.0)
|
20 (4.0)
|
8 (1.6)
|
17 (3.4)
|
17 (3.4)
|
8 (1.6)
|
|
In dormitory with students
|
190 (37.7)
|
204 (40.5)
|
228 (45.2)
|
166 (32.9)
|
360 (71.4)
|
34 (6.7)
|
|
At home with parents
|
36 (7.1)
|
49 (9.7)
|
34 (6.7)
|
51 (10.1)
|
72 (14.3)
|
13 (2.6)
|
|
Employment
|
|
|
<0.0001
|
|
|
<0.0001
|
|
|
0.732
|
|
Employed
|
29 (5.7)
|
72 (14.2)
|
31 (6.1)
|
70 (13.8)
|
91 (17.9)
|
10 (2.0)
|
|
Not employed
|
203 (40.0)
|
203 (40.0)
|
239 (47.1)
|
167 (32.9)
|
361 (71.2)
|
45 (8.9)
|
|
Marital status
|
|
|
0.811
|
|
|
0.038
|
|
|
0.086
|
|
Single
|
83 (16.4)
|
104 (20.5)
|
89 (17.6)
|
98 (19.3)
|
171 (33.7)
|
16 (3.2)
|
|
Engaged
|
131 (25.8)
|
153 (30.2)
|
156 (30.8)
|
128 (25.2)
|
253 (49.9)
|
31 (6.1)
|
|
Married
|
18 (3.6)
|
18(3.6)
|
25 (4.9)
|
11 (2.2)
|
28 (5.5)
|
8 (1.6)
|
|
Family income
|
|
|
|
|
|
0.001
|
|
|
0.003
|
|
Low
|
5 (1.0)
|
20 (3.9)
|
0.019
|
8 (1.6)
|
17 (3.4)
|
17 (3.4)
|
8 (1.6)
|
|
Middle
|
191 (37.7)
|
206 (40.6)
|
|
228 (45.0)
|
169 (33.3)
|
363 (71.6)
|
34 (6.7)
|
|
High
|
36 (7.1)
|
49 (9.7)
|
|
34 (6.7)
|
51 (10.1)
|
72 (14.2)
|
13 (2.6)
|
|
Fathers' education
|
|
|
0.857
|
|
|
0.066
|
|
|
0.535
|
|
Primary school
|
5 (1.0)
|
8(1.6)
|
6(1.2)
|
7(1.4)
|
11(2.2)
|
2(0.4)
|
|
Secondary school
|
101 (19.9)
|
117(23.1)
|
104(20.5)
|
114(22.5)
|
198(39.1)
|
20(3.9)
|
|
University or postgraduate
|
126 (24.9)
|
150 (29.6)
|
160 (31.6)
|
116 (22.9)
|
243 (47.9)
|
33 (6.5)
|
|
Mothers' education
|
|
|
<0.0001
|
|
|
<0.0001
|
|
|
0.01
|
|
Primary school
|
30 (5.9)
|
73 (14.4)
|
31 (6.1)
|
72 (14.2)
|
93 (18.3)
|
10 (2.0)
|
|
Secondary school
|
201 (39.6)
|
196 (38.7)
|
236 (46.5)
|
161 (31.8)
|
356 (70.2)
|
41 (8.1)
|
|
University or postgraduate
|
1 (0.2)
|
6 (1.2)
|
3 (0.6)
|
4 (0.8)
|
3 (0.6)
|
4 (0.8)
|
|
Physical activity
|
|
|
0.001
|
|
|
<0.0001
|
|
|
0.054
|
|
Vigorous
|
1 (0.2)
|
5 (1.0)
|
3 (0.6)
|
3 (0.6)
|
3 (0.6)
|
3(0.6)
|
|
Moderate
|
184 (36.3)
|
177 (34.9)
|
212 (41.8)
|
149 (29.4)
|
323 (63.7)
|
38 (7.5)
|
|
Inactive
|
47 (9.3)
|
93 (18.3)
|
55 (10.8)
|
85 (16.8)
|
126 (24.9)
|
14 (2.8)
|
Abbreviation: SD, standard deviation.
The frequency of tobacco smoking, alcohol consumption, and cannabis use by gender
is given in [Fig. 2]. Male participants use more frequently alcohol compared with females.
Fig. 2 The prevalence of tobacco smoking, drinking, and cannabis abuse by gender and frequency
in the past month (%).
In the multiple logistic regression for dependent variable tobacco, smoking is associated
with lower odds of female gender (OR: 0.393, 95% CI: 0.257–0.601; p < 0.0001), higher odds of drinking alcohol in the past year (OR: 5.700, 95% CI: 3.7395–8.692;
p < 0.0001), and cannabis use in the past year (OR: 8.122, 95% CI: 2.392–27.580; p = 0.001; [Table 4]).
The logistic regression model for dependent variable alcohol consumption showed an
association with lower odds of female gender (OR: 0.588, 95% CI: 0.385–0.897; p = 0.014), greater odds of having self-income (OR: 2.612, 95% CI: 1.544–4.421; p < 0.0001), cigarette smoking in the past year (OR: 5.366, 95% CI: 3.498–8.232; p < 0.0001), as well as cannabis use in the past year (OR: 3.298, 95% CI: 1.502–7.245;
p = 0.003).
However, the logistic regression model for dependent variable cannabis abuse is associated
with lower odds of being female (OR: 0.337, 95% CI: 0.167–0.682; p = 0.002), higher odds of mothers' secondary school education (OR: 2.436, 95% CI:
1.113–5.332; p = 0.026), and university education (OR: 20.087, 95% CI: 3.000–29.422; p = 0.002), smoking tobacco in the past year (OR: 8.586, 95% CI: 2.506–29.422; p = 0.001), and alcohol consumption in the past year (OR: 3.558, 95% CI: 1.576–8.030;
p = 0.002).
Discussion
In this study, we aimed to identify the risk factors of tobacco, alcohol, and cannabis
use among university students. It has been confirmed that smoking behaviors are linked
with the sociodemographic and health-related variables (gender, income and physical
activity as well as the living spaces, employment, and mother's education). Similarly,
several factors that influence the consumption of alcohol and drugs have been analyzed.
Exposure to smokers (friends, parents, and teachers), easy access to tobacco, low
socioeconomic status, poor academic performance, low self-esteem, lack of perceived
risk of use, and lack of skills to resist influences regarding tobacco use are factors
associated with cigarette smoking among the youth.[15]
[16]
Our findings coincide with formerly published evidence[17]
[18] that smoking tobacco and drinking alcohol are more common that cannabis usage worldwide.
Friends who smoke, use drugs and/or alcohol, influence or instigate students to begin
consuming these substances.[3]
[19]
[20] Young people often reach out toward the first smoke, the first alcoholic drink,
or the first dose of drug just out of curiosity, and the desire to become a part of
a special social clique comes afterwards.[20]
The study findings showcase that the rate of tobacco consumption has become higher
among male students in comparison to that among female ones in the past year and in
the past month. The studies[21]
[22]
[23]
[24]
[25] that have examined this connection present higher numbers of smokers among male
students, and we have received the same results. In general, men tend to smoke at
higher rates than women.[26] Such differences may be a result of a combination of cultural, traditional, and
behavioral factors.[27] Surprisingly, in one study done in Brazil,[28] the gender variable was not linked with smoking.
In addition, male students, in particular, tend to consume alcohol more often and
in higher quantities, mainly during social gatherings and for social enhancement motives.[18]
[29]
Regarding cannabis consumption, the data of our study are comparable with the reported
data of other studies.[19]
[30] Approximately 10.8% of students have disclosed that they have smoked cannabis in
the past 12 months, and 8.3% in the previous 30 days. Our study, along with associating
studies,[30]
[31] reports a higher frequency of cannabis consumption in males and those of higher
family income.
Students that start consuming alcohol and drugs do it so they can appear more social,
more attractive, and more mature in comparison to their peers. Women usually have
been found to smoke tobacco to appear more elegant (in relation with weight control).[24]
This is in line with another study,[32] where the author confirms that the consumption of any of these illicit drugs amid
Kosovar students is 7%; it is relatively low compared with the average ESPAD,[33] which is 20%. Roughly 10% male students and 4% female students have tried illicit
drugs at least once in their life. This pattern is similar to the one noted in ESPAD
countries. Similar to ESPAD countries, the most popular and important drug in Kosovo
is cannabis.[32]
We have also observed the simultaneous consumption of tobacco, alcohol, and cannabis.
A student who smokes is more likely to consume alcohol and vice versa. These results
are consistent with other studies, where students who smoke seem to be at an increased
risk for alcohol consumption[34] and those who drink alcohol take more cigarettes during drinking episodes.[35] Furthermore, the consumption of tobacco and/or alcohol may be associated with the
use of illegal substances (e.g., cannabis).[20]
[29]
[30]
Several researches[22]
[28]
[31]
[36] have measured potential associations between socioeconomic status and substance
use behavior among students. Our study exhibited that community-level features (i.e.,
unemployment, living setting, and family income) were associated with the prevalence
of smoking, alcohol drinking, and using cannabis. Additionally, the study[22] displayed that people living in more economically deprived areas were more exposed,
and subsequently more prone, to smoking, compared with people living in less-deprived
areas. Verifying these discoveries, others have revealed that living in regions with
lower mean income is connected with a larger probability of smoking.[36] Moreover, while some studies have suggested that heavy drinking is more widespread
in regions with low socioeconomic status,[28] different studies have perceived that the highest levels of alcohol consumption
are linked with a higher socioeconomic status.[22]
[31]
[36] Other studies have also indicated that alcohol-drinking problems are associated
with a high socio-economic level.[23]
[29]
In our study, there was no statistically significant difference between students from
private and public institutions on lifetime, in the past 1 year/1 month of tobacco
smoking, alcohol consumption, and cannabis use (p > 0.05). Kosovar students who attend private colleges generally belong to families
with high-income earnings and have a more tolerant family environment, in regard to
alcohol use. Demirbas[23] reported that students who graduated from private high schools had an increased
risk of drinking fortnightly or more frequently. Likewise, a study[37] showed that in Iranian community students in private schools are at higher risk
for use of cigarette and marijuana.
Thus, this study emphasizes the significance of being aware of the factors linked
with cannabis, alcohol, and tobacco consumption among university students, along with
recognizing potential students who are at greater risk of consumption. This can contribute
to the management, planning, creation, and application of more impactful interferences
in health education programs, or motivational and psychoeducational interferences
to raise awareness among students concerning these issues and decrease the consumption
behaviors.[38] Likewise, student consumption policies should be managed with interdisciplinary
action; it must not be left unnoticed. Proof has showcased that such adjustments in
laws and rules are necessary to bring about changes in the social norms of student/campus
life.[39]
Strengths and Limitations
Strengths and Limitations
The findings of this study must be reflected in light of the following limitations.
Primarily, the study was cross-sectional, so causal inferences cannot be made. Second,
the study relied on self-reported information, which could raise probable matters
associated with social desirability bias. Since cannabis is still deemed an illicit
substance, students might have under- reported their own substance use. Additionally,
heavier consumers might not have been present when the study was administered. Lastly,
the student participation was from only one region of Kosovo and the results cannot
be generalized for the whole country. In future research, the study sample may be
larger, representing all regions of the country.
Conclusion
This study highlighted that smoking, drinking, and cannabis are highly prevalent among
university students, notably among male students. Further, we observed the simultaneous
consumption of tobacco, alcohol, and cannabis. The consumption of tobacco and/or alcohol
was associated with the use of cannabis and vice versa. As the results of our study
reveal, using one of these three substances is a risk factor for the use of others.
These findings can help program managers and policy makers to better understand the
current situation of substance-using students, and therefore devise effective and
appropriate control programs and policies for university students. Providing careful
attention to the risk factors will benefit prevention and treatment efforts that are
specific of substance use in adolescents.
Table 4
Multiple logistic regression analysis of tobacco, alcohol, and cannabis use in the
past 12 months
|
Tobacco
|
Alcohol
|
Cannabis
|
|
OR (95% CI)
|
p-Value
|
OR (95% CI)
|
p-Value
|
OR (95% CI)
|
p-Value
|
|
Gender
|
|
|
|
|
|
|
|
Female
|
0.393 (0.257–0.601)
|
<0.0001
|
0.588 (0.385–0.897)
|
0.014
|
0.337 (0.167–0.682)
|
0.002
|
|
Male
|
1
|
|
1
|
|
1
|
|
|
Employment
|
|
|
|
|
|
|
|
Has self-income
|
–
|
–
|
2.612 (1.544–4.421)
|
<0.0001
|
–
|
–
|
|
Doesn't have self-income
|
|
|
1
|
|
|
|
|
Mothers' education
|
|
|
|
|
|
|
|
Primary school
|
–
|
–
|
–
|
–
|
1
|
|
|
Secondary school
|
|
|
|
|
2.436 (1.113–5.332)
|
0.026
|
|
University
|
|
|
|
|
20.087 (3.000–134.496
|
0.002
|
|
Last year tobacco smoke
|
|
|
|
|
|
|
|
No
|
–
|
–
|
1
|
|
1
|
|
|
Yes
|
|
|
5.366 (3.498–8.232)
|
<0.0001
|
8.586 (2.506–29.422)
|
0.001
|
|
Last year alcohol use
|
|
|
|
|
|
|
|
No
|
1
|
|
–
|
–
|
1
|
|
|
Yes
|
5.700 (3.739–8.692)
|
<0.0001
|
|
|
3.558 (1.576–8.030)
|
0.002
|
|
Last year cannabis abuse
|
|
|
|
|
|
|
|
No
|
1
|
|
1
|
|
–
|
–
|
|
Yes
|
8.122 (2.392–27.580)
|
0.001
|
3.298 (1.502–7.245)
|
0.003
|
|
|
Abbreviations: CI, confidence interval; OR, odds ratio.
