MA Alexander Oni A

MPH Master Thesis
By
Alexander Adebayo Oni
Hamburg, September 2013
Supervisor: Prof. Dr. Ralf Reintjes

Supervisor: Dr. Osasuyi Dirisu
Department of Public Health

Faculty of Life Sciences
Hamburg University of Applied Sciences
Germany

STATUTORY DECLARATION
I hereby declare that I am the individual author of this thesis, which is now submitted for
assessment at Hamburg University of Applied Sciences leading to the award of Master of
Public Health.
I certify that, to the best of my knowledge, this thesis was completed with reasonable care to
ensure that the work is original and does not violate any law of copyright.
Hamburg, September 2013
Signed by
Alexander Oni

ACKNOWLEDGEMENT
I am immensely grateful and appreciative for the technical advice, time and dedication to
this project by my supervisors; Prof. Dr. Ralf Reintjes and Dr. Osasuyi Dirisu.
I thank the Lagos State Government for giving me the opportunity to carry out this research
in Lagos Island, Nigeria. I am grateful to the various Coordinators (all through my study)
and the entire members of staff of the Department of Public Health, Hamburg University of
Applied Sciences for the foundational knowledge and support, which enabled me carry out
this project.
My Special thanks go to Prof. Zollner, Prof. Afolami, Dr. Folu Olatona, Dr. Deyemi Segun,
Mr. Korede Afolami, Mr. Lawrence and my fellow MPH students for their valuable
comments, suggestions and logistical support.
I am indebted to Alhaja Adeniyi and her entire household for providing me love and shelter
in Lagos, Nigeria throughout the project. The fieldwork that ultimately became this thesis is
the culmination of the sacrifice and support of countless individuals to whom I am forever
grateful.
Lastly, I am grateful to my parents, Dr & Mrs Ayodele Oni, my brother Opeyemi and my
fiancé, Olajumoke for their unconditional love and support for more than 3 decades. I
couldn’t have had a better family in life.
To God be the glory, great things He hath done.

ABSTRACT
BACKGROUND
Peer influence has consistently been found to be among the strongest predictors of substance
use among adolescents by many literatures around the world including some Nigerian
articles. However, Nigeria lacks literature that explores the various contexts and patterns of
adolescents’ substance use based on the influence of their peers. Therefore, this research
attempts to show evidence of peer influence in the context of susceptibility to peer pressure,
temptation to smoke and self-efficacy to use substances in various forms among adolescents
in Lagos Island, Nigeria.
METHODS
A school based cross-sectional survey using anonymous self-administered questionnaires
was carried out among 257 respondents from 4 senior secondary schools in Lagos Island,
Nigeria. This was achieved by using simple random sampling technique. The collected data
was analyzed with IBM SPSS Statistics 17 software.
RESULTS
For all the substances considered, about 75% of users admitted to being tempted to smoke in
positive, negative and habitual/craving situations while about 50% of non-users admitted
likewise. Users of substances are more susceptible to peer pressure to carryout perceived
deviant activities than their counterpart non-users. When socializing with peers, it appears
more boys are tempted to smoke than girls. Boys also appear to have a higher self-efficacy
to smoke when anxious, stressed or angry and in habitual/craving situations than girls. As
the adolescents grow older, they are more open to admit susceptibility to peer pressure to
use substances when asked but willingness to disclose use of illicit substances is generally
low.
DISCUSSION & CONCLUSION

The study showed that there is significant temptation to smoke in positive, negative and
habitual/craving situations among users, but the findings are also remarkable in non-users.
There is pressure on non-substance-using-adolescents to join their substance-using close
friends in smoking and drinking in social situations. Also, they eventually over time develop
confidence in carrying out this act of substance use. Moreover, once an adolescent starts
using, the study makes it clear perpetual use is reinforced within the adolescent peer
clusters; making the temptation to keep using even stronger than before initiation. As these
adolescents closely mingle with new non-substance using peers (e.g. new boy/girlfriend or
best friend), the influence is continually perpetuated thereby completing the revolving
pathway of peer influence on substance use among adolescents.

EXPLORING PEER INFLUENCE AS A PATHWAY TO
ADOLESCENCE SUBSTANCE USE IN NIGERIA
TABLE OF CONTENT
PAGE
Statutory Declaration…………………………………………………………………… ii
Acknowledgement……………………………………………………………………… iii
Abstract………………………………………………………………………………… iv
Table of Content…………………………………………………………….………… v
1.0 Introduction………………………………………………...…………………… 1
1.1 Background on Nigeria………………………………………………...... 1
1.2 History of Drug Use in Nigeria………………………………………..... 2
1.3 Literature Review on Demographic Pattern of Drug Use in Nigeria…… 3
1.4 Nigerian Drug Laws and Policies…………………………………….… 4
1.5 Drug Abuse Treatment In Nigeria…………………………………….... 5
2.0 Background on Peer Influence in Adolescent Substance Use………..……….... 6

2.1 Risk Factors for Adolescent Drug Use……………………………..…... 6
2.2 Peer Influence…………………………………………………….…….. 8
2.3 Literature Review on Peer Influence and Adolescent Substance Use:
Global Evidence…………………………………………………..…...... 9
2.4 Literature Review on Peer Influence and Adolescent Substance Use:
African and Nigerian Evidence……………………………….………… 10
2.5 Theoretical Framework……………………………………….……….... 12
2.6 Literature Review on Peer Influence, Self-Efficacy and
Adolescent Substance Use……………………………………............... 16
2.7 Study Goal, Research Objectives/Questions & Justification of Study.... 18
3.0 Methodology…………………………...………………………………….…… 20
3.1 Study Design………………………………………………………........ 20
3.2 Setting…………………………………………...................................... 21
3.3 Minimum Sample Size………………………………………….......….. 22
3.4 Population & Sampling………………………...……………………..... 22

3.5 Procedure…………………………………….......................................... 23
3.6 Instrument……………………………………………………………..... 24
4.0 Results and Discussion………………………………………………….………. 26

4.1 Demographic Characteristics of Respondents………………….………. 26
4.2 Prevalence of substance use among respondents……………………...... 26
4.3 Assessment of willingness to disclose substance use…………………… 30
4.4 Age, sex & peer pressure……………………………………………….. 31
4.5 Lifetime substance use & peer pressure………………………………… 31

4.6 Temptation to smoke in positive social situations……………………… 33
4.7 Temptation to smoke in negative social situations……………………… 34
4.8 Temptation to smoke in habitual & craving situations…………………. 35
4.9 Discussions……………………………………………………………… 37
4.10 Limitation of Study……………………………………………………... 42
4.11 Conclusion & Recommendation………………………………………… 43
5.0 Reference………………………………………………………………………… 45
LIST OF TABLES
1.0 Factors Underlying Formation of Peer Clusters……………………………….. 13
2.0 Research Objectives & Questions………………………………………………. 18
3.0 Percentage of substance users admitting to peer pressure………………………. 32
LIST OF FIGURES
1.0 Social Cognitive Theory: Bandura’s Concept………………………………….. 16
2.0 Sex description of respondents…………………………………………………. 26
3.0 Distribution of substance use & Percentage distribution of
users and non-users for various substances…………………………………..... 27
4.0 Sex distribution of substance use……………………………...……………….. 28
5.0 Age of onset of substance use………………….………………………………. 29
6.0 Percentage of lifetime users that are current users……………………………... 29
7.0 Willingness to disclose substance use………………………………………….. 30
8.0 Temptation to smoke in positive social situations…….……………………….. 34
9.0 Temptation to smoke in negative social situations…………………………….. 35
10.0 Temptation to smoke in habitual/craving situations…………………………… 37
11.0 Pathway of Peer Influence on substance use among adolescents……………… 41

APPENDIX
APPENDIX A: Youth School Survey Questionnaire…………………………………. 50
APPENDIX B: Information Sheet/Consent Form…………………………………….. 53
APPENDIX C: Ethical Approval Letter………………………………………………. 55
APPENDIX D: Permission Letter…………………………………………………….. 56
LIST OF ABBREVIATIONS
NDLEA National Drug Law Enforcement Agency

UK United Kingdom
CIA Central Intelligence Agency
GDP Gross Domestic Product
UNICEF United Nations Children’s Fund
ICPC Independent Corrupt Practice Commission
EFCC Economic and Financial Crime Commission
UNODC United Nations Office of Drug and Crime
NEEDS National Economic Empowerment and Development Strategy
DCMP Drug Control Master Plan
GYTS Global Youth Tobacco Survey
PCT Peer Cluster Theory
SCT Social Cognitive Theory
WHO World Health Organization

CHAPTER 1
INTRODUCTION
1.1. BACKGROUND ON NIGERIA
Nigeria is situated in the West African region and lies between longitudes 3 degrees
and 14 degrees, latitudes 4 degrees and 14 degrees. Nigeria is the most populous
black nation in the world with an estimation of 162,470,737 people as at 2011
(World Bank, 2013). This population is made up of about 374 distinct ethnic stocks.
The major ethnic groups are Yoruba, Hausa and Igbo; collectively making up over
40% of the population. The gender divide of Nigeria's population, as indicated by the
last census in 1991, reflected 51% of the population to be males while 49% were
females. (Nigerian High Commission, UK, 2013)
In addition to its huge population, Nigeria is endowed with natural resources.

Notable cash crops in Nigeria are cocoa, cotton, groundnuts, oil palm and rubber
(Nigerian High Commission, UK, 2013). However, by value, crude oil is Nigeria’s
biggest mineral resource and mainstay of wealth generation considering the fact that
Nigeria is the 6th biggest exporter of crude oil in the world out of 210 exporting
countries with estimated 2,051,000 barrels/day (CIA, 2013). Nigeria has a Gross
Domestic Product of $243,985,812,280 (World Bank, 2013)
Despite all these natural endowment of wealth Nigeria possesses as a nation, there
are various ironical problems of poverty that eats deep into the fabric of the Nigerian
society and threatens the future of Nigerian adolescents and youths in general.
According to the United Nations Children’s Fund, “Nigeria possesses a stark
dichotomy of wealth and poverty. Although the country is rich in natural resources,
its economy cannot yet meet the basic needs of the people. Such disparity between
the growth of the GDP and the increasing poverty is indicative of a skewed
distribution of Nigeria’s wealth” (UNICEF: Nigeria, 2013).
As at 2012, Nigeria is the 35th most corrupt nation in the world (Transparency
International, 2012). Corruption is one of the major challenges in Nigeria, raising the
cost and risk of doing business in the country and making the country unattractive to
investors (UNICEF, 2013).
'

In the effort to curb corruption in Nigeria, Legislators passed the Anti-Corruption bill
and the Executive arm of Government established anti-corruption agencies like
Economic and Financial Crime Commission (EFCC) and Independent Corrupt
Practices Commission (ICPC) in 1999.
The Unemployment Rate in Nigeria increased to 23.9% in 2011 from 21.1% in 2010
(Trading Economies, 2013). Currently, it is at an all-time high of 30.6% (National
Bureau of Statistics, 2013). Health care and general living conditions in Nigeria are
poor, especially for children and women. Infant and under-five mortality rates are
high. The weak health system has led to low coverage of primary health
interventions with attending high disease burden. Nigeria’s educational system is
also in a state of neglect largely due to decaying institutional infrastructure. This
compromises quality education for the Nigerian child (UNICEF, 2013).
As part of Nigeria’s plan for overcoming poverty and generating national wealth and
employment, the Federal Government developed the National Economic
Empowerment and Development Strategy (NEEDS) in 2004. NEEDS has four
elements: re-orientating values, reducing poverty, creating wealth and generating
employment. The NEEDS project is currently in its second phase of implementation.
(UNICEF, 2013)
1.2. HISTORY OF DRUG USE IN NIGERIA

Drug abuse became a public health issue in Nigeria in the 1960s with the discovery
of cannabis farms in the country, arrests of Nigerian cannabis traffickers abroad, and
reports of psychological disorders suspected to be associated with cannabis use. By
the 1980s, the abuse of cocaine and heroin was added to the public health burden.
Soldiers and sailors returning from Second World War introduced cannabis into
Nigeria. The later introduction of cocaine and heroin into Nigeria was attributed to
Nigerian Naval Officers in training in India who were involved with trafficking
activities in the early 1980s (Obot, 2003).
Nigeria is a transit point for heroin and cocaine intended for European, East Asian,
and North American markets. Since 2004, drug trafficking organizations have been
increasingly using West African countries including Nigeria for smuggling large
amounts of cocaine from South America into Europe and North America
consequently increasing the availability and use of cocaine and heroin. Nigeria
(

currently has the third highest one-year prevalence of cocaine and opioids use in
Africa at 7% for both drugs (UNODC, 2011).
The most abused illicit drug in Nigeria is cannabis, mainly in its herbal form. This is
due to the fact that cannabis is home grown and relatively cheap. The price of one
unit of cannabis is often about the same as that of a bottle of beer (UNODC, 2013).
At 14.3%, the country has the highest one-year prevalence rate of cannabis use in
Africa (UNODC, 2011) (Onifade et al, 2011). The average globally assessed
prevalence rate of cannabis use is 3% (UNODC, 2013).
1.3. LITERATURE REVIEW ON DEMOGRAPHIC

PATTERN OF DRUG USE IN NIGERIA
There is no current data on the demographic pattern concerning substance use in
Nigeria but the general perception is that most involved age group are the youths.
Available data are center based and can’t be generalized for the whole Nigerian
population.
In a comprehensive review of 28 psychiatric units in health facilities in Nigeria by

Ohaeri and Odejide, a total of 10,396 patients were assessed and cannabis was the
most prevalent drug of abuse (77%), followed by alcohol and amphetamines in the
northern part of Nigeria, while in the south, cannabis (60.6%) was followed by
heroin and cocaine. The prevalence of abuse was more in males than females
(Adamson et al, 2010)
In another review of drug abuse patients admitted at Yaba Psychiatric Hospital,

Lagos, Nigeria, Lawal et al found the mean age to be 29.15 ± SD 5.9 years. They
were mostly single, with formal education, heroin/cocaine were the most prevalent
drugs of abuse (84%), followed by cannabis (76.3%), then alcohol (22.5%).
Adelekan & Adeniran, in a follow up study among 62 drug abusers at the Drug
Abuse Unit of the Neuropsychiatric Hospital, Aro, Abeokuta reported that the
patients were mostly single, males with formal education, with cannabis being the
most commonly abused drug (53.5%) with over half of the cohorts below 30 years of
age. Similarly in the same center, another study gave the mean age of onset of drug
use among inpatients to be between the adolescent age range of 15-19 years within a
span of 1992 to 1997 and 2002 to 2007 (Adamson et al, 2010).
)

1.4. NIGERIAN DRUG LAWS AND POLICIES
The worsening of Nigerian involvement in substance abuse and international drug
trade cannot be attributed to lack of drug policy and laws because Nigeria happens to
have one of the most drastic drug laws in the world.
The Indian hemp decree of 1966 stipulated that cultivation of cannabis attracts death
penalty or 21 years jail term. Cannabis exportation was punishable by 10 years of
imprisonment. A stiff penalty of at least 10 years in jail was reserved for those found
smoking or in possession of the drug and cocaine/heroin trafficking attracted a death
penalty. This law was amended in 1975 and less severe penalties were instituted. For
example, the death penalty was abolished and the punishment for cannabis smoking
was reduced to six months and/or a fine. The death penalty was later re-introduced in
1984 through the Special Tribunal Decree by a new military government then to
emphasize their seriousness in clamping down offenders. At least three cocaine
traffickers were killed by firing squad before the law was repealed and replaced with
life imprisonment in 1986 (Obot, 2003).
The most significant drug law in Nigeria has been the National Drug Law
Enforcement Agency (NDLEA) Decree of 1989, a response to the United Nations
Convention against Illicit Traffic in Narcotics Drugs and Psychotropic Substances of
1988. Among many of its provisions, the NDLEA Decree set up an agency of the
same name and listed the punishment for drug offences, including the forfeiture of
assets of arrested persons. In this Decree, trafficking of cocaine, LSD, heroin, or
similar drugs is punishable by life imprisonment, while possession or use attracts a
sentence of 15 years but not exceeding 25 years (Obot, 2003)
One of the drug policies implemented by Nigerian National Drug Law Enforcement
Agency (NDLEA) was the Drug Control Master Plan (DCMP) launched in 1999
with the aim of achieving a drug free society (Obot 2003). In 2008, the NDLEA
recorded the seizure of 335,535.34 kilograms of cannabis, 530.40 kilograms of
psychotropic substances, 3655.49 kilograms of cocaine and 11.61 kilograms of
heroin (UNODC, 2013). Despite all policies and efforts by the Nigerian Government
to combat drug trafficking, Nigeria was for many years regarded as the major hub for
drug trafficking and money laundering and transit point between the world’s western
and eastern drug hemispheres by the International Narcotics Control Strategy Report
(Obot, 2003)
*

1.5. DRUG ABUSE TREATMENT IN NIGERIA
Historically, the orthodox treatment of substance abuse in Nigeria took place in
general psychiatric settings until 1983 when the first stand-alone substance abuse
treatment unit was established. Since then, many more substance abuse treatment
units have evolved, existing alongside psychiatric units. However, there is no current
national database of the structures and services developed to combat substance abuse
problem in Nigeria (Onifade et al, 2011).
In 1998, the United Nations International Drug Control Program conducted a rapid
situation assessment of drug abuse in Nigeria with one of the objectives being to
determine the availability, adequacy, nature and location of secondary and tertiary
drug prevention services and personnel. The study was conducted in 22 of the 36
states, covering all the 6 geopolitical zones in the country. The study revealed that
substance abuse treatment facilities existed in all the 22 states but largely as part of
psychiatric, general or university teaching hospitals. The report also indicated the
existence of traditional and religious centers for substance abuse treatment and
rehabilitation (Onifade et al, 2011).
In 2011, Onifade et al carried out a cross sectional survey with the aim of
determining the types, spread and characteristics of substance abuse treatment
centers in Nigeria. 31 units were invited and participated in filling an online
questionnaire, adapted from the European Treatment Unit/Program Form (June 1997
version). According to the study, 17 of them belonged to Non-Governmental
Organizations, 3 belonged to private individuals and 11 were subunits of Psychiatric
Departments of Federal and State Hospitals. Overall, only half of these units were
officially dedicated for provision of treatment for substance abuse. There was no
identified sustainable network or a common evaluation framework among substance
abuse treatment units in Nigeria.
It is pretty clear that so much effort over a long period of time has been put into
supply reduction in Nigeria without significant reward in curbing the problem of
substance abuse while demand reduction efforts are skeletal without proper co-
ordination. Understanding the nature and characteristics of most vulnerable group
(which are the youths) is paramount to devising a sustainable and effective demand
reduction program in Nigeria. This study aims to explore this.
+

CHAPTER 2
BACKGROUND ON PEER INFLUENCE IN ADOLESCENT SUBSTANCE USE

2.1. RISK FACTORS FOR ADOLESCENT SUBSTANCE ABUSE
Understanding the risk factors surrounding substance use among adolescents provide
the platform to pinpoint possible potential targets for intervention and subsequently
curbing the problem. These risk factors are roughly divided into two. First are broad
societal and cultural (i.e. contextual) factors, which provide the legal and normative
expectations for behavior. The second group includes factors that lie within
individuals and their interpersonal environments. (Hawkins et al, 1992).
2.1.1. CONTEXTUAL FACTORS

People exist socially as individuals or groups in accordance to certain values and
structures in their society. Some of these structures and how it influences substance use
are explored as follows:
1. Laws: Raising taxes on the sale of licit substances like alcohol and tobacco has been
proven to be effective in reducing their use among adolescence and the general public.
Specifically, age restriction laws on who can be sold alcohol have reduced teenage use.
However laws making drugs like marijuana illegal has not reduced its cheap retail price
or its availability in most societies.
2. Availability of Drugs: This depends partly on laws but can be considered as a separate
factor. Studies have shown that the more a substance (licit or illicit) is available in a
particular environment, the higher the prevalence of use in that environment.
3. Extreme Economic Deprivation: Although, there is no consistency in relationship

between someone’s socio-economic status and drug use, it is important to note that
extreme poverty coupled with childhood behavioral problems as been strongly linked to
future likelihood of drug abuse.
4. Neighborhood Disorganization: Rough dwelling places (i.e. places with high human
traffic, poor public place surveillance and high adult crime rate) are associated with high
prevalence of adolescent drug abuse. (Hawkins et al, 1992).
,

2.1.2. INDIVIDUAL AND INTERPERSONAL FACTORS
The following are individual characteristics with their immediate personal
environment which have been known to influence adolescent drug use
1. Physiological Factors: Many studies link varying enzyme level across races to predict
level of alcohol consumption. However, worthy of note is the fact that poor impulse
control in childhood is a predictor of frequent marijuana use at 18 years (Shedler et al,
1990).
2. Family Drug Behavior and Attitude: Poor parenting practices, high levels of conflict
in the family, and a low degree of bonding between children and parents appear to
increase risk for adolescent problem behaviors generally, including the abuse of alcohol
and other drugs (Brook et al, 1990).
3. Poor and Inconsistent Family Management Practices: Initiation of drug use by

adolescent is predicted by inconsistent parental discipline, lack of maternal involvement
in a child’s development and low parental educational aspirations for a child. (Kandel et
al, 1987).
4. Early and Persistent Problem Behaviors: The greater the variety, frequency, and
seriousness of childhood antisocial behavior, the more likely antisocial behavior is to
persist into adulthood and the more likely a child is prone to drug use. (Robin, 1978).
5. Alienation and Rebelliousness: Alienation from the dominant values of society, low
religiosity and rebelliousness has been associated with drug use and delinquency.
(Hawkins et al, 1992).
6. Academic Failure: Academic failure in school associated with truancy, early drop out
from school or school absenteeism is a prognostic factor to adolescent drug use.
(Holmberg, 1985).
7. Early Onset of Drug Use: Early onset of drug use is said to predict subsequent misuse
of drugs. Also, the earlier the onset of a particular drug use, the greater the frequency of
use and the more likely to be involved in use/misuse of other drugs. (Hawkins et al,
1992).
-

8. Peer Influence and Association with drug using Peers: Peer use of substances has
consistently been found to be among the strongest predictors of substance use among
youth. In fact, the influence of peers on adolescent drug use is stronger than that of
parents for White American, African American, Asian American and Hispanic American
youths. (Newcomb et al, 1986).
2.2. PEER INFLUENCE

2.2.1. DEFINITIONS
Peers are a group of people of the same age, status or interests. Peers could include
friends, classmates, team members or co-workers. Influence is the effect that a
person or thing has on another. Influences can be positive or negative (Alberta
Health Services, 2009)
Peer Influence is defined as pressure, planned or unplanned, exerted by peers to

influence personal behavior (Glossary of Education, 2013). It is a peer or group of
peers trying to persuade you to think or act in a certain way, or to make a particular
decision (Alberta Health Services, 2009).
2.2.2. FORMS OF PEER INFLUENCE

• Peer influence comes in a variety of forms. It can be:
• Positive e.g. peers may influence others to become involved in a school sports
team or club.
• Negative e.g. peers may influence others to try alcohol, tobacco, other drugs or
gambling.
• Direct e.g. peers may put deliberate pressure on a friend to play poker for money
at lunch.
• Indirect e.g. someone might want to belong to a peer group that is playing poker
at lunch, and might copy their behavior to fit in with the group. (Alberta Health
Service, 2009)
• Peer influence is evident in children and adults alike, but children who are still in
the process of developing a value system are more vulnerable to negative
influences (Rimm, 2013). Therefore, it is imperative to teach adolescents
personal coping skills to resist negative influences leading to drug use.
.

2.3. LITERATURE REVIEW ON PEER INFLUENCE AND ADOLESCENT
SUBSTANCE USE: GLOBAL EVIDENCE
Gardner and Steinberg carried out an experimental study titled “Peer Influence on
Risk Taking, Risk Preference, and Risky Decision Making in Adolescence and
Adulthood”. In this study, 306 individuals in 3 age groups (in years) namely:
adolescents (13–16), youths (18–22), and adults (24 and older) all completed two
questionnaire measures assessing risk preference and risky decision making, and one
behavioral task measuring risk taking. Analyses indicated that (a) risk taking and
risky decision making decreased with age; (b) participants took more risks, focused
more on the benefits than the costs of risky behavior, and made riskier decisions
when in peer groups than alone; and (c) peer effects on risk taking and risky decision
making were stronger among adolescents and youths than adults. These findings
support the idea that adolescents are more inclined toward risky behavior and risky
decision making than adults and that peer influence plays an important role in
explaining risky behavior during adolescence. (Gardner & Steinberg, 2005)
Although, an adolescent may carry out risky behavior as a result of the influence of
peers, close parental monitoring can dampen this exuberance. In 1994, Steinberg et
al carried out a longitudinal study on parental monitoring and peer influence on
adolescent substance use in Wisconsin and Northern California. The study showed
parental monitoring is a protective factor against drug use and poorly monitored
adolescents are more likely to use drugs. It also showed that drug-using adolescents
seek out like-minded friends. Once an adolescent associates with drug-using peers,
his or her own substance use approaches their level (Steinberg et al, 1994). In a
similar fashion, Mount & Steinberg also demonstrated the positive impact of having
a high-achieving friend is stronger among adolescents whose parents are relatively
more authoritative; while the deleterious impact of having a drug-using friend is
stronger among adolescents whose parents are relatively less authoritative. (Mount &
Steinberg, 1995)
Steinberg’s work shows that the group of friends an adolescent keeps dictates his/her
type of peer influence (positive or negative) and the degree of parental supervision is
key in determining the type of peer influence an adolescent will experience. In a
study carried out by Shilts on 237 7th and 8th graders, several trends emerged from
data on users, abusers, and nonusers of drugs/alcohol. Abusers reported little
involvement in extracurricular activities, spent more time with friends than with
family, and identified friends as individuals who use/abuse drugs and alcohol.
/

Users differed from abusers in their reported reasons for substance use and in the
percentage of students who reported that friends were substance users. Non-using
students tended to be highly involved in extracurricular activities and spent more
time with family and less time with peers/friends. (Shilts, 1991).
This definitely raises the question of how will we determine which group of friends
an adolescent will choose in life; is it the abusers or users or non-users and what
really makes them choose any of these groups? A two-stage model of peer influence
in adolescent substance use carried out by Uberg K et al showed that: (1) adolescents
who did not value school achievement or spending time with parents were more apt
than others to choose friends who smoked cigarettes more than they did. (2) Only
high peer acceptance and high friendship quality resulted in adolescents being more
apt to conform to their friend's substance-use behaviors. (Uberg et al, 2003).
Furthermore, in a study on peer influence and selection mechanisms, Ashby and

Sean pointed out that difficult temperament, poor self-control, and deviance-prone
attitudes were related to an initial choice of peers an adolescent move with. They not
only concluded that temperament related attributes predisposes an adolescent to early
experimentation and deviant-peer affiliations but also emphasized that peer influence
is the most potent factor during middle adolescence in determining their choices
(Ashby & Sean, 1999).
2.4. LITERATURE REVIEW ON PEER INFLUENCE AND SUBSTANCE USE:

AFRICAN & NIGERIAN EVIDENCE
Rudatsikira et al carried out a study on the prevalence and determinants of adolescent
tobacco smoking in Addis Ababa, Ethiopia. The researchers used the data from
Global Youth Tobacco Survey (GYTS) 2003 to determine smoking prevalence,
determinants, attitudes to, and exposure to tobacco advertisements among 1868
adolescents. The results showed that having smoking friends was strongly associated
with smoking after controlling for age, gender, parental smoking status, and
perception of risks of smoking (OR = 33; 95% CI [11.6, 95.6]). Male gender and
having one or both smoking parents were associated with smoking. Perception that
smoking is harmful was negatively associated with being a smoker (odds ratio 0.3;
95% confidence interval, 0.2–0.5).
'&

However there was a low prevalence of smoking in the study because out of 1868
respondents, only 4.5% males and 1% females were identified to be smokers.
(Rudatsikira et al, 2007)
Not in all cases do we have a negative association between peer influence and
adolescent substance use. In fact peer support was said to be a protected factor
against tobacco use in a study carried out in 6 African countries (Kenya, Namibia,
Swaziland, Uganda, Zambia and Zimbabwe). Karl Peltzer carried out this study
among 20,765 students aged from 13 to 15 years to assess the prevalence and
correlates (mental distress and protective factors) of substance use among school-
going adolescents. Other results in the study showed that school truancy, loneliness,
sleeping problems, sadness, suicidal ideation, suicide plans, and poverty were
associated with substance use (tobacco, alcohol & illicit drugs), while school
attendance and parental supervision and connectedness were protective factors for
substance use. (Peltzer, 2009)
In Nigeria, some relevant studies on peer influence as it relates to substance abuse

have been carried out.
Adelekan et al carried out a cross sectional study published in 1993 among

University of Ilorin undergraduate students titled “Psychosocial correlates of alcohol,
tobacco and cannabis use: findings from a Nigerian university”. The results showed
that peer influence, self-reported poor mental health, religiosity, parental/guardian
supervision, perceived availability and perceived harmfulness were the identified
factors that emerged as common correlates for the use of alcohol, tobacco and
cannabis. The study also identified males to be more involved in smoking and
drinking and found a positive association between cannabis use and polygamous
family background.
A cross sectional study on the prevalence of psychoactive substance use among

commercial motorcyclists and its health and social consequences was carried out in
Zaria, Nigeria. All 200 motorcyclists involved in the study were males with age
range of 21-25years.
''

Peer influence, keeping awake, and suppression of fatigue were the identified factors
influencing psychoactive substance use. The commonest used substances are
cannabis (25.8%), solution (24.5%), caffeine (15.8%) and coffee (4.8%). A high
prevalence of road traffic accident (59.5%) was associated with the use of
psychoactive drugs among the motorcyclists in the study. (Alti-Muazu et al, 2008).
A descriptive cross sectional study on psychoactive substance use amongst 215 out-
of-school adolescents in two communities in a Local Government Area in Nigeria
showed that the two important sources of introduction to tobacco use were friends
(72%) and relatives (20%). Use of tobacco amongst significant others were: friends
(27%), fathers (8.0%), relatives (4.2%) and mothers (0.5%). The most common
sources of supply were motor parks (52%) and friends (16%). The study showed that
peer influence is an important source of introduction to tobacco use while selling of
tobacco to adolescents in youth aggregation areas is common. (Adebiyi et al, 2010).
In a cross sectional study carried out in Ojo, Lagos, Nigeria, among 1000
undergraduate students living outside university campus, it was found that
Family/Peer influence had the highest percentage (25.1%) out of all predisposing
factors to drug use and addiction. Other factors were don’t fit (15.3%), depression
(15.1%), low self-esteem (14.3%), personality (9.9%), drug availability (8.6%),
poverty (6.4%) and genetic predisposition (5.4%). The students were between 19 to
30 years of age.
Coffee (43.1%) was the most commonly used drug, followed by alcohol (25.8%) and
marijuana (7.4%). Despite chronic use of these drugs (5 years and above), addiction
is not reported to be a common finding. The study also revealed the poor attitudes of
the undergraduates to drug addicts even after rehabilitation. The study concluded that
the awareness, knowledge, practices and attitudes of Nigerian undergraduates
towards drug abuse are very poor. (Oshikoya et al, 2006).
2.5. THEORETICAL CONSIDERATIONS FOR THE STUDY

The use of theories is important for guidance and direction to scientific research.
They are also used has a foundational basis to understand public health issues and
consequently provide efficient and sustainable solutions.
2.5.1. PEER CLUSTER THEORY (PCT)

Oetting and Beauvias developed this theory in 1986 as a template to explain the use
of drugs by adolescents. After a decade of extensive research work and
'(

identification of the psychosocial characteristics responsible for drug use in
adolescents, they consistently found out the highest correlations related to drug use
were from peer encouragement to use drugs and peer sanctions against drug use.
Eventually, Peer Cluster Theory emerged from trying to understand the importance
of peer influence and how it relates to key psychosocial characteristics in adolescent
substance use. (Oetting & Beauvais, 1986).
Psychosocial characteristics set the stage for drug use; making an adolescent
susceptible or innocuous to drug use. Adolescent drug use is strongly linked to
membership in small groups of people including best friends, boy and girlfriends,
close siblings within the same age bracket etcetera.
These groups are peer clusters which: (1) introduce the drug and make it available
(2) teach the adolescent how to use it (3) formulate values, beliefs, attitudes and
rational that propagate it's continuous use (4) formulate group membership and
identification around drug use. (Oetting & Beauvais, 1986)
TABLE 1: SOURCE: OETTING & BEAUVAIS, 1986.

Psychosocial Characteristics Associated with Adolescent Drug Use: Factors Underlying
Formation of Drug/Non Drug Using Peer Clusters
Social Structure Age, sex, ethnic group, religion, socio-economic status, family structure
Socialization Links Religious identification, family relationships, family sanctions against drugs,
social success, liking for school, peer sanctions against drugs, peer
encouragement to use drugs
Psychological Self-confidence, feeling of social acceptance, shyness, social isolation,
characteristics unhappiness, anxiety, feeling “blamed”, anger
Attitudes & Beliefs Tolerance of deviance, importance of being a good person, expectancy for
the future, belief in drug dangers
Rationales Like drugged feeling, use at parties, bored, use with friends, reducing social
anxiety, feeling unhappy, to be free, to get back at parents, sex, feeling
lonely, being angry
Behaviors Drug use, deviant behaviors, peer context
Drug use is viewed as one of the symptoms of psychosocial problems. Other symptoms of
psychosocial problems can be vandalism, precocious sexuality, criminal acts and the likes.
However, psychosocial problems are not viewed as the sole cause of drug use. In fact,
')

established drug use can eventually also lead to psychosocial problems. Therefore, in respect
to causation between drug use and psychosocial problems, we have a viscous circle. Drug
use is not a problem in which cause and effect can be separated. It is a complex, interactive
system in which the chain of cause and effect cannot be easily broken. (Oetting & Beauvais,
1986).
Peer Cluster Theory provides basis for intervention strategy (especially for trained
counselors working with adolescents). To help an adolescent who is using drug, one needs
to identify his/her peer cluster: where, when and with whom drug is used, the rationale
behind its use and how it determines the identity and membership in the cluster. Unless an
adolescent is guided in associating with non-drug using clusters, there is little hope in
stopping drug use. It is also important to identify the underlying psychosocial conditions that
predispose the adolescent to drug use because if they are not taken care of, the adolescent is
vulnerable to going back to drug use after stopping. (Oetting & Beauvais, 1986).
Peer Cluster Theory applies to most scenarios of adolescent drug use. However, there are
notable exceptions. The theory disregards biological and hormonal influences, which could
predispose to adolescent drug use. When an adolescent is not using drugs in social contexts
or is exclusively or intensely focused on the excessive use of a particular drug,
physical/neurological and personality problems should be explored. (Oetting & Beauvais,
1986)
2.5.2. SOCIAL COGNITIVE THEORY (SCT)

In 1941, Miller and Dollard proposed the theory of social learning. In 1963, Bandura
and Walters broadened the social learning theory with the principles of observational
learning and vicarious reinforcement. Bandura added his concept of self-efficacy in
1977, which led to the emergence of Social Cognitive Theory (by Bandura) in 1986.
(University of Twente, Theory Clusters, 2013)
Social Cognitive theory explains how people acquire and maintain certain behavioral
patterns, while also considering the social environment in which they perform the
behavior. The theory takes into account a person's past experiences, which dictates
whether behavioral action will occur. Like peer cluster theory, it also provides a
basis for intervention strategies. The goal of Social Cognitive Theory is to explain
how people regulate their behavior through control and reinforcement to achieve
goal-directed behavior that can be maintained over time. (University of Boston,
Behavioral Change Model, 2013).
'*

The 6 constructs of Social Cognitive Theory are as follows:
1. Reciprocal Determinism - This is the central concept of SCT. This refers to the
dynamic and reciprocal interaction of person (individual with a set of learned
experiences), environment (external social context), and behavior (responses to stimuli
to achieve goals).
2. Behavioral Capability - This refers to a person's actual ability to perform a behavior

through essential knowledge and skills. In order to successfully perform a behavior, a
person must know what to do and how to do it. People learn from the consequences of
their behavior, which also affects the environment in which they live.
3. Observational Learning - This asserts that people can witness and observe a behavior
conducted by others, and then reproduce those actions. This is often exhibited through
"modeling" of behaviors. If individuals see successful demonstration of a behavior,
they can also complete the behavior successfully.
4. Reinforcements - This refers to the internal or external responses to a person's behavior

that affect the likelihood of continuing or discontinuing the behavior. Reinforcements
can be self-initiated or in the environment, and reinforcements can be positive or
negative. This is the construct of SCT that most closely ties to the reciprocal relationship
between behavior and environment.
5. Expectations - This refers to the anticipated consequences of a person's behavior.

Outcome expectations can be health-related or not health-related. People anticipate the
consequences of their actions before engaging in the behavior, and these anticipated
consequences could influence successful completion of the behavior. Expectations
derive largely from previous experience. While expectancies also derive from previous
experience, expectancies focus on the value that is placed on the outcome and are
subjective to the individual.
6. Self-efficacy - This refers to the level of a person's confidence in his or her ability to
successfully perform a behavior. Self-efficacy is unique to SCT although other theories
have added this construct at later dates, such as the Theory of Planned Behavior. Self-
efficacy is influenced by a person's specific capabilities and other individual factors, as
well as by environmental factors (barriers and facilitators). (University of Boston,
Behavioral Change Model, 2013).
'+

Social Cognitive Theory assumes that changes in the environment will automatically
lead to changes in the person, which may not always be true. The theory is loosely
organized, based solely on the dynamic interplay between person, behavior, and
environment. It is unclear the extent to which each of these factors into actual behavior
and if one is more influential than another. It focuses on processes of learning and in
doing so disregards biological and hormonal predispositions that may influence
behaviors, regardless of past experience and expectations. The theory does not focus on
emotion or motivation, other than through reference to past experience, thereby
providing minimal attention on these factors. Lastly, the theory can be broad-reaching,
so can be difficult to operationalize in entirety. (University of Boston, Behavioral
Change Model, 2013)
FIGURE 1. SOCIAL COGNITIVE THEORY: BANDURA’S CONCEPT

Source: Jessica Ring, 2013
2.7 LITERATURE REVIEW ON PEER INFLUENCE, SELF-EFFICACY AND

ADOLESCENT SUBSTANCE USE
From the above Peer Cluster and Social Cognitive theories, it is certainly of interest to
find out if there is a positive correlation between peer influence, self-efficacy and
substance use and to see if there are other factors that probably moderate this correlation.
This is worthy of note not just because the two variables (peer influence and self
efficacy) are the crops of the two theories but it will give a guide to understanding the
degree of strength of these variables in dictating the nature and behavior of adolescents
in order to have more clarity of the pathway to adolescent substance use and how to map
out effective and sustainable intervention programs in Nigeria.
2.6 LITERATURE REVIEW ON PEER INFLUENCE, SELF-EFFICACY AND

ADOLESCENT SUBSTANCE USE
From the above Peer Cluster & Social Cognitive theories, it is certainly of interest to
find out if there is a positive correlation between peer influence, self-efficacy and
substance use and to see if there are other factors that probably moderate this correlation.
This is worthy of note not just because the two variables (peer influence and self
efficacy) are the crops of the two theories but it will give a guide to understanding the
degree of strength of these variables in dictating the nature and behavior of adolescents
in order to have more clarity on the pattern of adolescent substance use and how to map
',

out effective and sustainable intervention programs in Nigeria.
A longitudinal study was carried out by researchers from Texas to examine the relationships
among peer influence, self-efficacy, stress, family environment and adolescent alcohol use
and to test for the potential moderating effects of parental expectations regarding adolescent
alcohol use.
The findings showed that parental expectations of adolescent alcohol use significantly
moderated all structural relationships, and greater parental disapproval was associated with
less involvement with friends and peers who use alcohol, less peer influence to use alcohol,
greater self-efficacy for avoiding alcohol use, and lower subsequent alcohol use and related
problems. (Nash et al, 2005).
This research clearly shows that with parental disapproval of alcohol use, there exists an
inverse relationship between peer influence and self-efficacy for avoiding substance use.
Also, many studies have pointed to the fact that parental encouragement of substance use is
a significant predictor of an adolescent’s use (see section 2.4).
However, in a study carried out in Texas by Flay et al using structural equation modeling of
smoking influence, parental smoking was seen to only have an indirect effect on
adolescents’ will to initiate smoking, whereas friends smoking (peer influence) had both
direct and indirect effect on the will to initiate smoking by an adolescent. In fact, peer
influence had a stronger effect on adolescents' smoking behavior. This shows that there is
increased self-efficacy for use of substance in the midst of smoking habit of significant
others like peers and parents but more because of influence of peers. (Flay et al, 1994).
With the above studies in Texas, one would assume that the substance use behavior of
significant others like parents and peers automatically determine the direction of self-
efficacy of the adolescent (either to use drugs or to avoid using drugs) thereby eroding the
place of self will (to choose the direction by the adolescent) and makes self-efficacy the least
important factor (in comparison to peer influence and parental influence) when it comes to
adolescent substance use. This may not be the case in all instances.
In a study carried out to identify moderators of peer influence in adolescent smoking, it was
discovered that self-efficacy judgments significantly moderated the predictive effects of peer
influence (peer smoking and peer approval) on smoking tendencies. Other considered
moderators were parental supervision after school, self-esteem, perceived stress and gender.
(Stacy et al, 1992).
'-

The study by Stacy et al shows that an adolescent can still develop confidence/will to avoid
substance use even in the presence of significant others who use drugs. These finding is
consistent with Social Cognitive theory which suggests that self-efficacy can act as a buffer
that either protect the adolescent against social influence or make the adolescent more
susceptible to such influence.
2.7. STUDY GOAL, RESEARCH OBJECTIVES/QUESTIONS &

JUSTIFICATION OF STUDY
STUDY GOAL
This study attempts to explore the context in which peer pressure and self-efficacy relate to
substance use among secondary school adolescents in Lagos Island, Nigeria; with a view to
make evidence based recommendations for health promotion.
TABLE 2. RESEARCH OBJECTIVES AND QUESTIONS

Research Objectives Research Questions
1. Describe the pattern of use of various What is the pattern of use for common substances
substances among adolescents in Lagos used by adolescents?
Island, Nigeria. What substance is used most among adolescents and
why?
What is the level of willingness of adolescents to
admit to use of illicit substances?
2. Explore the context in which peer What is the adolescents’ perception of peer pressure
pressure relates to adolescents substance on their choices to use various substances?
use In what context does peer pressure dictate the
initiation of substance use among non-using
adolescents?
In what context does peer pressure ensure the
continuation of substance use among adolescents
who already use one substance or the other?
3. Explore the context in which self- What are the various situations in which an
efficacy relates to adolescents substance adolescent develops confidence to use a substance?
use In what context does self-efficacy dictate adolescent
substance use across gender and among users and
non-users of substances?
.
'.

JUSTIFICATION OF STUDY
All studies carried out in Nigeria concerning substance abuse have only been able to point
out/identify peer influence as one of the possible factors responsible for substance use
amongst young adults and in this regard, very few studies were carried out specifically on
adolescents. However, the various contexts or pathways in which peer influence plays a
major role in explaining substance use among Nigerian adolescents is not fully understood.
Therefore, this study will attempt to show evidence of peer influence in the context of
susceptibility to peer pressure, temptation to smoke and self-efficacy to use substances in
various forms among adolescents in Lagos Island, Nigeria.
'/

CHAPTER 3
METHODOLOGY
3.1. STUDY DESIGN
A school based cross-sectional survey using anonymous self-administered
questionnaires was adopted. The choice of a school-based study using senior
secondary school students as against out-of-school adolescents is based on the
following:
1. It is cost effective and relatively easy to conduct. Moving around to look for out of
school adolescents will require substantially high logistic cost compared to going to
designate schools. Gaining access to out-of-school adolescents is extremely challenging
and administering questionnaires in informal settings is cumbersome.
2. It is easy to choose an appropriate school and respective classes needed that will have
desired number of adolescents. Achieving this with out-of-school adolescents (usually
the ones on the streets or dangerous drug joints) will require the use of key opinion
leaders within the drug environment to help in gathering them. Such services are pricy.
3. Students are usually available in classes on school days and school hours compared to
out-of-school adolescents who may not have a specific time to reach them in large
numbers.
4. Young people feel more comfortable admitting to illegal or socially disapproved

behaviors such as drug use in the school setting (when assured of confidentiality) rather
than the home setting when the parents are present or even in the next room.
5. The mode of data collection is relatively easy to standardize and control in school
settings because the researcher can employ the use of schoolteachers to maintain order
(only).
6. The response rate in school surveys is usually high. In fact, the response rate in most
studies is equal to the number of students present in class on the day of data collection;
refusals are uncommon in most surveys. (UNODC, Conducting School Surveys On Drug
Abuse, 2003)
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However, since there is the assumption that out of school adolescents and adolescents who
make themselves absent from classes are more prone to deviant behaviors like smoking
illicit substances (UNODC, 2003)(Holmberg, 1985), the researcher is taking the risk of
missing out a vital population to the study, which could make it more difficult to generalize
the results for all adolescents in Lagos State.
The choice of a cross sectional study is based on the following:

1. It allows the researcher to measure peer influence and self-efficacy (the exposures) as it
affects substance use (the outcome) at the same time in senior secondary school
adolescents, therefore saving cost (labor, time and money) of coming back to follow up
the outcomes.
2. It can be performed quickly which makes it cost effective
3. It is suitable to explore issues of substance abuse and smoking as it relates to adolescents
4. A control group is not needed (unlike analytical and experimental studies), the
researcher doesn’t need to interfere actively in the study (unlike experimental studies),
and he/she only needs to observe the variables.
5. It can be used to generate hypothesis for further testing at the end of the study
However, this study cannot establish a causal relationship between the variables, the
researcher can only show if there is a possible correlation, which can be subjected to
further testing.
The choice of a self-administered questionnaire is based on the fact that the respondents
(senior secondary school adolescents) are educated enough to read and write answers for
simple and easy to understand questions. The researcher adopted “fill-in-forms” as
against using machine-readable forms because of financial constraints.
3.2. SETTING.
The research was conducted in four senior secondary schools located in Lagos Island
Local Government in Lagos State.
Lagos Island Local Government is one of the 20 Local Governments in Lagos State,
Nigeria. It is 9km squared in area having a total population of 859,849 people with
461,830 males and 398,019 females. Lagos State in itself has a population of over 17
million people (Lagos State Bureau of Statistics, 2005). There are 10 senior
secondary schools in Lagos Island (Lagos State List of Schools, 2012).
('

3.3. MINIMUM SAMPLE SIZE
Nigeria has a 14.3% one-year prevalence rate of cannabis use as at 2011 (UNODC,
2011). However, the prevalence rate among Nigerian adolescents for any substance
use is not known and the countries prevalence rate on alcohol and tobacco
consumption is not known.
Globally, 2 billion adults (48% of the adult population) are current users of alcohol,
1.1 billion adults (29% of the adult population) are current smokers of cigarettes and
185 million adults (4.5% of the adult population) are current users of illicit drugs;
indicating that prevalence of illicit drug use is less than one-tenth that of alcohol use
and less than one-fifth that of tobacco use (Anderson, 2006)
RULE OF TEN
This concept is used in sampling to ascertain a sample size appropriate to achieve a valid
result in a study. This method considers the minimum sample size a researcher needs to
perform a factor analysis and achieve a valid result for the population being studied.
(Vittinghoff et al, 2007).
With the above facts in mind, using the Rule of Ten, minimum sample size for this study
was calculated using the cannabis prevalence rate (of 14.3%) bearing it in mind these will
presumably be the lowest prevalence rate between tobacco, alcohol and cannabis. Using 2
independent variables (peer influence and self-efficacy) and 1 dependent variable (substance
abuse), the researcher was able to mathematically arrive at a minimum sample size of 139
adolescents as shown below
100/14.3 × 20 = 139
The researcher was eventually able to use 257 respondents in this study, which is
conveniently higher than the minimum sample size.
3.4. POPULATION & SAMPLING

Simple random sampling method is adopted for the study
Adolescents in Lagos Island, Lagos State, Nigeria are the target population. Logbook of all
senior secondary schools in Lagos Island was adopted as the sample frame. This is provided
by Lagos State Ministry of Education online.
((

A standard document for random sampling to pick as many classes that will cover the
desired number of students for the study was considered for use. However, in order to
minimize disruption of regular school activities, the school Principals exercised their
prerogative in handpicking the senior secondary classes to be used.
3.5. PROCEDURE
The questionnaire was designed using existing validated and reliable scales. A pilot
study was carried out among 17 respondents in an all-male senior secondary school
(in Ogun State, Nigeria) to test the questionnaire and necessary adjustments were
made. Afterwards, the questionnaire was administered on respondents in the
designated schools.
Under the directive and consent of the Lagos State Ministry of Education, the
research team approached the Principals of selected schools. The research team
explained the importance of the research and its advantages as regards national
planning and development with the aim of convincing the Principals to allow the
schools to be used for the study despite the inconveniences the study may cause (e.g.
disruption of regular school activities etcetera).
During the collection of data, class teachers were excused in order to make the
students feel free to fill their substance use history without fear of punishment. The
research team maintained order in the classes and explained the purpose of the study
to the students. The primary unit of survey was the senior secondary classes and all
students were encouraged to participate although Students were given the choice of
participation or to decline participation. Apart from an initial verbal explanation
made about the study to the students, Information Sheets/Consent Forms (See
Appendix B) were given to all students to read (before filling the questionnaire) and
sign (after filling the questionnaire).
The students were informed that an external team (not the school authority) is
conducting the study. Teachers were not allowed to wander in between the rows
when the students were filling the questionnaires. These encouraged an honest
response from the students.
Data collection in a school was carried out at the same time in all participating
classes. The main reason for this was to avoid discussions in the breaks that might
influence the answers of those students who have not yet taken part in the study.
()

In other to improve the perception of anonymity, the research team ensured the students
were spaced out in the classrooms while answering the questionnaires. Students were
reminded not to write their names or any form of identification on the questionnaires.
The study is in keeping with the guidelines of the Nigerian Ethics and Medical Research
Committee. The Ethics Committee of the Lagos University Teaching Hospital in Lagos
State approved the study under the directive of Nigerian Ethics and Medical Research
Committee in Federal Capital Territory of Nigeria, Abuja (See Appendix C). Also, a
permission letter was issued from the Lagos State Ministry of Education to use secondary
school children in Lagos Island. (See Appendix D).
3.6. INSTRUMENT
A self-administered questionnaire titled “Youth Survey Questionnaire” (see
Appendix A) was created by borrowing 3 scales in original format that are deemed
reliable and valid. These scales were aimed at collecting information on personal
drug history, susceptibility to peer pressure and self-efficacy as it relates to
adolescents substance use.
The scale about personal drug history titled “About You” was adopted from a WHO
Youth Survey Questionnaire (WHO, 1980). The peer pressure scale (titled “About
You & Your Friends” in the questionnaire) was adopted from a research work titled
“Susceptibility to Peer Pressure, Self Esteem, and Health Locus of Control as
Correlates of Adolescents Substance Abuse” (Dielman et al, 1987).
To assess self-efficacy as it relates to adolescent substance use, a short version of a

“self-efficacy/temptation scale” designed by Velicer and colleagues in 1990 was
adopted (Velicer et al, 1990). It was titled “About Being Tempted” in the
questionnaire. This scale also provided vital information about peer pressure.
Retitling of the scales was done in the questionnaire to make it easy to understand
and attractive to fill by adolescents. All substances in which questions were asked
were described with popular slang names for the adolescents to recognize.
Considering the feedback of respondents after pretesting the questionnaires among 17 male
students in a secondary school in Abeokuta, Ogun State, Nigeria, the researcher modified
the following questions in the “About Being Tempted” section (self-efficacy/temptation
scale)
(*

Question 4: Over coffee when talking & relaxing. It was modified to “Over lunch when
talking & relaxing” because eating lunch is a better description of a regular activity in the
Nigerian context as against drinking coffee among adolescents.
Question 5: “When I feel I need a lift” was replaced with “When I feel I need inspiration”.
This is because it is a local believe in Nigeria that substance use gives inspiration to sing &
respondents during pre-testing could not relate with the initial question.
(+

CHAPTER 4
RESULTS AND DISCUSSION
4.1 DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS

This chapter discusses the results obtained from this study. Two hundred and fifty
seven (257) students served as total number of respondents. Figure 1 shows the sex
distribution of the respondents. Majority (64.5 %) of the respondents used in this study
were males and 33.5% of respondents were females. The ratio of females to males is 1
female to 1.9 males. 2.3% of respondents didn’t indicate their sex.
FIGURE 2. SEX DISTRIBUTION OF RESPONDENTS

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The age distribution of the students was between 15 – 20 years; with 40.5% of the
respondents being 15 years of age, 31.5% being 16 years of age and 23.7% of the
respondents being between the ages 17-20 years.
All the respondents used in this study were in senior secondary school with majority of
them in SS1 (Senior Secondary School 1). The rest were in SS2 or did not indicate
their class.
4.2 PREVALENCE OF SUBSTANCE USE AMONG RESPONDENTS

Figure 3 shows the proportion of adolescents that have used different substances
before in their lifetime. Alcohol is the most used substance among the respondents
with 100 adolescents (38.9% of total respondents) admitting to drinking alcohol.
Strikingly, 4.7% of the respondents have used cocaine before and 22.6% have taken
sedatives/cough syrups without doctor’s prescription. 12.5% of them have smoked
tobacco while 6.6% of them have used cannabis before.
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FIGURE 3a. DISTRIBUTION OF SUBSTANCE USERS

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FIGURE 3b. PERCENTAGE DISTRIBUTION OF USERS AND NON-USERS

FOR VARIOUS SUBSTANCES
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Figure 4 shows the sex distribution of use of substances among respondents. For all
substances, the total number of males admitting to use is more than double the number
of females. Considering the ratio of females to males in this study (1 female to 1.9
males), this may reflect that the males are using all the categories of substances more
than the females. However, this conclusion should be made with caution since we
already have the gender distribution skewed towards males than females.
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FIGURE 4. SEX DISTRIBUTION OF SUBSTANCE USE
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Figure 5 shows age of onset of substance use. For all the 5 categories of substances,
majority of respondents started using substance at ages 13-16 years. However, for
adolescents that use cocaine and smoke tobacco or marijuana, the second most
conspicuous age of onset is 10years or below. For the peak age category of starting
substance use (13-16 years), the number of males initiated was more than double that of
the females for all categories of substances. For the proportion of total males to females
in this study (1 female to 1.9 males), this may mean more males started smoking at ages
13-16 years than the females. However, more females than males were initiated to using
cocaine and smoking tobacco and cannabis at 10 years of age or less.
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FIGURE 5. AGE OF ONSET OF SUBSTANCE USE
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Figure 6 shows proportion of “current users” among total number of respondents who
have used a substance in their lifetime (regarded as “lifetime users” in this study). It is
striking to see that 100% of respondents who have used cocaine before are still current
users; so is 64.7% and 55.2% of cannabis and sedative/cough syrup users respectively.
However, less than 50% of respondents who have used tobacco and alcohol before are
still current users.
FIGURE 6. % OF LIFE TIME USERS THAT ARE CURRENT

USERS
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KEY: Life time users= adolescents who have used a substance before in their life
Current users= adolescents who are currently using a substance.
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The study assessed frequency of substance use by respondents and the findings showed that
alcohol and cocaine users have remarkably high frequency of consumption than other
substances. For current users of alcohol, more respondents drink alcohol for 20 days or more
in 30 days than any other category of alcohol consumption (which are less than 20 days in
30 days). In fact, for cocaine, majority of current users (10 out of 13 respondents) use
cocaine on 6 or more days in 30 days (with 5 respondents taking cocaine for 6-19days and 5
other respondents taking cocaine for 20 days or more). A reverse trend is observed with
current users of cannabis and sedatives/cough syrups with current users taking these
substances only 5 days or less in 30 days. Frequency of use for tobacco was not assessed.
4.3 ASSESSMENT OF WILLINGNESS TO DISCLOSE SUBSTANCE USE

In assessing how many respondents will truthfully disclose if they are using a
substance (especially illicit), Figure 7 showed that more respondents will not disclose
their cannabis use than the ones who will and some are not sure if they should disclose
their use.
FIGURE 7. WILLINGNESS TO DISCLOSE SUBSTANCE USE

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4.4 AGE, SEX AND SUSCEPTIBILITY TO PEER PRESSURE
As regards substance use among adolescents:
Susceptibility to peer pressure is almost the same across gender. Overall, fewer
adolescents admitted their susceptibility to peer pressure when asked directly.
10.9% of total respondents (28 out of 257) admitted to susceptibility to peer pressure.
10.9% of males (18 out of 165) admitted to susceptibility to peer pressure while 11.6%
of females (10 out of 86) admitted to susceptibility to peer pressure. (Chi square=0.029,
p value=0.864).
On an average, the older an adolescent is the more open he/she is to admit susceptibility
to peer pressure when asked directly.
100% of 20 years old respondents (2 out of 2) admitted to being susceptible to peer

pressure. (Chi square=19.644, p=0.001).
15.8% of 18 years old respondents (3 out of 19) admitted to being susceptible to peer
pressure. (Chi square=19.644, p=0.001).
pressure (Chi square=19.644, p=0.001).
4.5. LIFE TIME SUBSTANCE USE AND SUSCEPTIBILITY

TO PEER PRESSURE
Table 3 assesses how many substance users are actually using substances based on
the influence of their peers. Generally for all the substances considered, more
lifetime users of each substance admitted to being susceptible to use substances
based on peer pressure than adolescents who are non-users of such substances.
33.3% of all respondents using cocaine (4 out of 12) admitted to being susceptible to
peer pressure while 8.7% of all respondents who have never used cocaine before (20
out of 229) admitted to being susceptible to peer pressure (Chi square value=7.695,
)'

p=0.006).
25% of all respondents using tobacco (8 out of 32) admitted to being susceptible to
peer pressure while 9% of respondents who have never used tobacco before (20 out
of 223) admitted to being susceptible to peer pressure (Chi square value=7.358,
p=0.007).
23% of all respondents using cannabis (4 out of 17) admitted to being susceptible to
peer pressure while 8.8% of all respondents who have never taken cannabis before
(20 out of 226) admitted to being susceptible to peer pressure (Chi square
value=3.828, p=0.05).
15% of all respondents taking alcohol (15 out of 100) admitted to being susceptible
to peer pressure while 8.6% of all respondents who have never taken alcohol (13 out
of 151) admitted to being susceptible to peer pressure (Chi Square value=2.479,
p=0.115).
12.1% of all respondents using sedatives/cough syrup (7 out of 58) admitted to being
susceptible to peer pressure while 9.3% of all respondents who have never used
sedatives/cough syrup before (17 out of 182) admitted to being susceptible to peer
pressure (Chi square value=0.364, p=0.546).
TABLE 3. PERCENTAGE OF SUBSTANCE USERS ADMITTING TO PEER
PRESSURE
% Of Total Life P Value.
Number Time Users Pearson Chi
Number of Admitting To Use Admitting to Square.
Total Life Based on Peer Use Based on Asymp. Sig.
Substance Time Users Pressure Peer Pressure (2 sided)
Tobacco 32 8 25 0.007
Alcohol 100 15 15 0.115
Cannabis 17 4 23.5 0.05
Cocaine 12 4 33.3 0.006
Sedative/Cough 58 7 12.1 0.546
Syrup
)(

4.6. TEMPTATION TO SMOKE IN POSITIVE SOCIAL SITUATIONS
Positive social situations that were assessed are when adolescents are socializing
with one another:
a. When with close friends at a party
b. Hanging out with a close friend/boyfriend/girl friend who is smoking
c. Having lunch with close friends
Unlike earlier on when susceptibility to peer pressure was almost the same across gender,
more boys are tempted to smoke than girls this time. Also, more respondents were willing to
admit their temptation to smoke due to peer pressure.
51.4% of total respondents (132 out of 257) admitted to being tempted to smoke.
57.4% of males (95 out of 165) admitted to being tempted to smoke while 38.4% of females
(33 out of 86) admitted to being tempted to smoke. (Chi square=11.669, p=0.009)
Figure 8 shows that for all the substances considered, users of each substance were more
tempted to smoke than non-users except sedatives/cough syrups. 41.7% of respondents who
have never drank alcohol in their life (63 out of 151) admitted to being tempted to smoke
while 77% of alcohol lifetime users (77 out of 100) admitted to being tempted to smoke.
(Chi square value=26.272, p=0.000)
50.9% of non-cannabis users (115 out of 226) admitted to being tempted to smoke while
70.6% of cannabis lifetime users (12 out of 17) admitted to being tempted to smoke. (Chi
square value=4.245, p=0.236)
51.1% of non-cocaine users (117 out of 229) admitted to being tempted to smoke while 75%
of lifetime cocaine users (9 out of 12) admitted to being tempted to smoke. (Chi square
value=3.82, p=0.282)
50.2% of non-tobacco users (112 out of 223) admitted to being tempted to smoke while
59.4% of lifetime tobacco users (19 out of 32) admitted to being tempted to smoke. (Chi
52.7% out of all respondents who has never used sedatives/cough syrups without a doctor’s
prescription (96 out of 182) admitted to being tempted to smoke while 48.3% of all
respondents who have used sedatives/cough syrups without a doctor’s prescription (28 out
of 58) admitted to being tempted to smoke. (Chi square value=1.310, p=0.727)
))

FIGURE 8. TEMPTATION TO SMOKE IN POSITIVE SOCIAL SITUATIONS
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4.7. TEMPTATION TO SMOKE IN NEGATIVE SITUATIONS

Negative situations that were assessed are when an adolescent is anxious and
stressed, angry about something or with someone or when frustrated.
Majority of respondents admitted to being tempted and more boys are tempted to
smoke than girls. 55.6% of total respondents (143 out of 257) admitted to being
tempted to smoke. 63.6% of males (105 out of 165) admitted to being tempted to
smoke while 39.5% of females (34 out of 86) admitted to being tempted to smoke. (p
value=0.005)
Figure 9 shows that for all the substances, users of each substance were more
tempted to smoke than non-users except for cannabis & sedative/cough syrups with
very close values. 47% of respondents who have never taken alcohol in their lifetime
(74 out of 157) admitted to being tempted to smoke while 77% of lifetime alcohol
users (77 out of 100) admitted to being tempted to smoke (Chi square value=11.466,
p=0.022).
56.2% of non-cannabis users (127 out of 226) admitted to being tempted to smoke
while 58.8% of lifetime cannabis users (10 out of 17) admitted to being tempted to
smoke. (Chi square value=1.027, p=0.899).
)*

56.3% of non-cocaine users (129 out of 229) admitted to being tempted to smoke while
66.7% of lifetime cocaine users (8 out of 12) admitted to being tempted to smoke (Chi
54.7% of non-tobacco smokers (122 out of 223) admitted to being tempted to smoke while
62.5% of lifetime tobacco smokers (20 out of 32) admitted to being tempted to smoke (Chi
of 58) admitted to being tempted to smoke. (Chi square value=4.362, p=0.359)
FIGURE 9. TEMPTATION TO SMOKE IN NEGATIVE SITUATIONS
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4.8. TEMPTATION TO SMOKE IN HABITUAL AND CRAVING SITUATIONS

Examples of habitual and craving situations that were assessed for are:
a. When a respondent first gets up in the morning
b. When a respondent feels he/she needs inspiration
c. When a respondent realizes he/she hasn’t smoked in a while
Almost half of respondents admitted to being tempted and more boys are tempted to smoke
than girls.
)+

48.6% of total respondents (125 out of 257) admitted to being tempted to smoke.
53.9% of males (89 out of 165) admitted to being tempted to smoke while 38.4% of females
(33 out of 86) admitted to being tempted to smoke. (p value=0.092).
Figure 10 shows that for all the substances, users of each substance were more tempted to
smoke than non-users except sedatives/cough syrups. 38.4% of respondents who have never
drank alcohol in their life (63 out of 151) admitted to being tempted to smoke while 64% of
alcohol lifetime users (64 out of 100) admitted to being tempted to smoke. (Chi square
value=17.236, p=0.002).
46.5% of non-cannabis users (105 out of 226) admitted to being tempted to smoke while
70.6% of cannabis lifetime users (12 out of 17) admitted to being tempted to smoke. (Chi
square value=13.411, p=0.004).
47.2% of non-cocaine users (108 out of 229) admitted to being tempted to smoke while 75%
of lifetime cocaine users (9 out of 12) admitted to being tempted to smoke (Chi square
value=9.704, p=0.021).
47.5% of non-tobacco users (106 out of 223) admitted to being tempted to smoke while
56.2% of lifetime tobacco users (18 out of 32) admitted to being tempted to smoke. (Chi
square value=16.387, p=0.003).
of 58) admitted to being tempted to smoke. (Chi square value=1.705, p=0.636).
),

FIGURE 10. TEMPTATION TO SMOKE IN HABITUAL/CRAVING SITUATIONS
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4.9. DISCUSSIONS
This section discusses the interesting results of the analysis and proposes possible
explanations for such results.
In the study, it appears that more boys are using substances than the girls for all the
categories of drugs considered. This goes along with the general societal notion that
boys are more adventurous and daring to try new things or do things that are
perceived to be risky and dangerous e.g. use of illicit substances like cocaine and
cannabis. It is also in keeping with the findings of the 1993 Adelekan et al and 2007
Rudatsikira et al research works in Africa (See Chapter 2.4). Although, since a
modeling method was not employed to adjust for the difference in the male to female
ratio, this conclusion should be made with caution because we already have the
gender distribution skewed towards males than females. The perception when a boy
smokes & drinks in Nigeria is that he is tough while for a girl, people are worried she
is loose and not “ladylike”. Despite the fact that the society generally frowns at
adolescents drinking and smoking at their perceived tender age, it is obvious from
this study they are not just drinking and smoking, they are involved in illicit
substance use, which cuts across gender.
)-

In fact, the study is prone to underreporting of the use of illicit substances (cannabis &
cocaine). Adolescents probably take these substances in hidden places (e.g. drug joints and
secluded corners of the streets); away from the prying eyes of adults. This owes to the fact
that majority of respondents (57.2%) made it clear they will not disclose their cannabis use
if they were in fact using. Only 20% of them were ready to be open. This collaborates the
idea expressed in the WHO Drug Use Questionnaire stating adolescents may not be willing
to disclose their drug use (WHO, 1980). This unwillingness to be open will be transferred to
people responsible for their upkeep like parents, teachers, guardians and older ones in the
neighborhood where they live. This is obviously so because boys and girls know they will
be reprimanded for their use by concerned parents, concerned enough to send them to school
for a brighter future.
Although the level of concern for adolescent substance use is extended to alcohol and
tobacco, they are usually with less scrutiny because they are legal substances, only not legal
to use at a certain age (less than 18 years). This may account for 132 out of 257 respondents
admitting to alcohol or tobacco use, making them the highest set of substances used
according to this study. Adolescents can easily purchase alcohol and tobacco without
presenting any identification in Nigeria. In the same vein, cough syrups and sedatives are
off-the-counter drugs and can be bought without a doctor’s prescription. This may account
for why sedatives/cough syrups are the second most used substance in this study (58 out of
257 respondents admitted to its use). Easy access of alcohol, tobacco and sedatives by
adolescents reflects poor governmental regulations on these substances.
Just like earlier studies carried out globally and in Nigeria (See Chapter 2), this study was
able to identify Peer Influence as one of the key factors in determining the use of substances
among adolescents but distinctively, tried to explore the various patterns of this influence. In
different situations where adolescents are socializing with one another, more than half of the
respondents (51.4%) admitted to being tempted to smoke. Although, when asked directly if
they feel their friends are in a way responsible for their use or non use of substances (or
other actions in general), only 10.9% admitted to susceptibility to peer pressure. This
demonstrates adolescents’ knowledge of substance use based on peer influence but in a
subtle way, shows adolescents don’t feel it is the only reason why they decide to use or not
to use a substance. On the other hand, these facts may simply point to the magnitude of their
unawareness of how much they do things (substance use in this regard) based on the
influence of their peers.
).

It seems peer influence cuts across gender and it is really not obvious which gender is most
affected by peer influence to use a substance. When eating, drinking and partying with close
friends, more males in this study admitted to been tempted to smoke (57.4% of total number
of boys as against 38.4% of total number of girls; Chi square=11.669, p=0.009). On the
other hand, when directly asked about the influence of close friends on their decision
making to use substance (or carry out any other perceived defiant activity for that matter),
percentage across gender seems the same in admitting to susceptibility to peer pressure in
dictating their choices (11.6% of total number of girls as against 10.9% of total number of
boys; Chi square=0.029, p value=0.864). At least in a social context, this may reflect boys
are more susceptible to peer influence as regards substance use than girls but when
confronted about it, both gender equally have fewer respondents willing to admit to it
although the later conclusion is not significant.
As expected, the percentage of substance users admitting to being tempted to smoke when
socializing with close peers are more than the percentages of non-substance users admitting
to the same scenario for alcohol, tobacco, cannabis and cocaine. This may be because users
not only have the knowledge, skills and the past euphoria of use to remind them of the much
anticipated pleasure to use again (as explained by the social cognitive theory), but unlike
non users, they may have formed a common ideology amongst their using peers which
strongly promotes their use every time they are together in clusters (as explained by the peer
cluster theory). The highest set of users admitting to being tempted to smoke is adolescents
who use alcohol (with 77% of them admitting to being tempted to smoke). This might be
because, socially, drinking and smoking are carried out together in the society as licit
substances; hence, one substance could easily serve as a gateway drug for another. From the
study 23% of people who take alcohol also smoke tobacco (Chi square=15.703 p=0.000).
Cocaine is known to be a very addictive substance. The study shows that 100% of all
adolescents who admitted to using cocaine before in their lifetime (12 out of 12 adolescents)
are still using cocaine at present. This indicates a craving pattern and dependency on cocaine
has probably been established. 75% of cocaine users (9 out of 12) admitted to being tempted
to smoke when socializing with close peers (Chi square=3.372, p=0.498). Although this is
not significant, it is however significant that 33.3% of all respondents using Cocaine (4 out
of 12) directly admitted to being susceptible to peer pressure (Chi square value=7.695,
p=0.006).
)/

Therefore, it is not surprising that for such adolescents, when they socialize with peers who
smoke, they easily feel like smoking too because their will not to use substances have been
severely eroded. Already from the study, we have 50% of cocaine users also smoking
tobacco (Chi square=16.34 p=0.000).
The pattern of Sedative/Cough syrup use may be a little different from the other substances
considered in this study. While it is “cool” to pop drinks and smoke in adolescent social
gatherings, it may be preferable to use pills and take cough syrups in less social contexts like
in your bedroom alone or privately with a close friend. This gives the impression that peer
influence may not be as strong in dictating sedative/cough syrup use like other substances
considered (at least from a social point of view). This notion is supported with the fact that
out of all respondents admitting to using one substance or the other, the sedative/cough
syrup category of users had the least percentage of users admitting to being susceptible to
peer pressure compared to other categories of users (12% for sedative users as against 15-
33.3% of users in other categories of substances). When an adolescent is not using
sedatives/cough syrups in social contexts or is exclusively or intensely focused on the
excessive use of sedatives/cough syrups, physical/neurological and personality problems
should be majorly explored rather than peer influence.
However, it is worthy to note that non-users have a noticeably high percentage amongst
them admitting to being tempted to smoke by the virtue of socializing with close peers
(41.7-52.7% of non-users for all category of substances considered). Close Peers that smoke
will provide an enabling environment for non-users to smoke & help them form ideology for
their continual use (peer cluster theory).
By observing close friends that smoke and act “cool”, non-users of various substances not
only learn how to reproduce the same actions (observational learning in social cognitive
theory) but gradually start developing interest and anticipate enjoying the same experience
they perceive their smoking friends enjoy (expectancies in social cognitive theory). This
anticipated enjoyment of smoking could build confidence in their ability to smoke (self-
efficacy in social cognitive theory) which leads to successful completion of the act in the
nearest future; thereby, completing the pathway of peer influence on substance use among
adolescents.
*&

FIGURE 11. PATHWAY OF PEER INFLUENCE ON SUBSTANCE USE
AMONG ADOLESCENTS
(4) Non-users develop

confidence in their
ability to smoke and
start smoking (self-
efficacy)
(1) Close Peers

smoking & acting
cool. They provide (3) Non-users
enabling environment anticipate enjoying
to smoke & help form same pleasure from
ideology for its smoking like close
continual use (peer peers (Expectancies)
cluster theory)
(2) Non-users learn

how to reproduce the
same actions
(Observational
learning)
Logically, despite the identified peer pressure adolescents face to use substances, without an
adolescent eventually using the substance, there is no remarkable prove of peer influence on
adolescents to use substances. While exploring peer influence to adolescent substance use,
this study identified that an eventual rate-determining step in deciding whether an adolescent
will eventually smoke or not smoke despite the peer pressure he/she may be facing is based
on confidence in his/her ability to carry out the action to smoke. This is known as Self-
Efficacy. Therefore, it is important to balance the study’s exploration of the “cause and
effect” of adolescent substance use (peer pressure being the “cause” and self-efficacy being
the “effect”)
Therefore, this study explored some life scenarios that urges an adolescent to develop
confidence in his/her ability to successfully carryout the use of a particular substance e.g.
smoking tobacco, cannabis etcetera. Although, this study puts in cognizance the fact that
*'

such developed confidence to smoke is influenced by individual and environmental factors
in which peer influence in itself is a key member. Knowing fully well that the extent to
which an individual is tempted to carry out an action is a full expression of the confidence
developed in one’s ability to carry out such an action, the study consequently measured self-
efficacy to smoke by ascertaining the temptation to smoke in different scenarios.
Scenario 1: When an adolescent is anxious and stressed, angry about something or with
someone or simply frustrated. The study showed that boys have a higher self-efficacy to
smoke than girls (63.6% of males tempted to smoke as against 39.5% of females). Also,
substance users (for all categories of substances) had a higher self-efficacy to smoke than
their counterpart non-users for all substances considered.
Alcohol seems to be the most influential substance in times of stress among adolescents
already into the use of one of the 5 substances considered; having the highest percentage of
self-efficacy to smoke (in these situations) among substance using adolescents (77% of
alcohol lifetime users are tempted to smoke as against 56.9%-66.7% of lifetime users of all
other substances considered in the study). These may simply be so because in Nigeria,
alcohol is licit, readily available, socially acceptable and easy to disguise for use. For
example, an adolescent may take alcohol in a soft drink container in order to avoid scrutiny.
Scenario 2: Habitual and craving situations like:

a. When a respondent first gets up in the morning
b. When a respondent feels he/she needs inspiration
c. When a respondent realizes he/she hasn’t smoked in a while
Just like negative situations, the study showed that boys have a higher self-efficacy to smoke
than girls (53.9% of males tempted to smoke as against 38.4% of females). Likewise,
substance users (for all category of substances) have a higher self-efficacy to smoke than
their counterpart non-users for all substances considered. However most interesting is the
fact that many adolescents habitually smoke in order to achieve inspiration for their dreams
like composing songs and becoming musicians. 70.6% of cannabis users smoke to achieve
inspiration while 54.9% of tobacco users smoke for the same reason. This may be because of
the notion that many successful Nigerian hip-hop musicians use cannabis to perform and
write songs and the youths want to be like them.
4.10. LIMITATION OF STUDY

For this study, it would have been most desired to serially explore the context in
which peer pressure and self-efficacy relate to substance use among adolescent with
*(

a Longitudinal Study so as to observe the trend over time. However, the time,
additional human and financial resource to do this is a constraint. The category of
analysis for the study is simple groups of users and non-users for each of the
substances considered. For each category of non-users for any particular substance,
there may be different subcategories of adolescents for example; non-users of
alcohol can be further divided into 1) non users of alcohol who are non-users of any
other substance considered 2) non users of alcohol who are users of tobacco 3) non
users of alcohol who are users of cocaine etcetera. The pattern of use for various
subcategories was not fully explored and this could be an avenue for further research
work.
4.11. CONCLUSION AND RECOMMENDATION

From the study, it is clear that there is pressure on non-substance using adolescents
to join their substance using close friends in smoking and drinking in social
situations. Also, they eventually over time develop confidence in carrying out this
act of substance use. Moreover, once an adolescent starts using, the study makes it
clear perpetual use is reinforced within the adolescent peer clusters; making the
temptation to keep using even stronger than before initiation. As this adolescent
closely mingle with new non-substance using peers (e.g. new boyfriend/girlfriend
etcetera) the influence is continually perpetuated hereby completing the revolving
pathway of peer influence on substance use among adolescents. These findings have
been drawn from adolescents going to school.
Schools are recognized as the citadel of acquiring knowledge and the platform to
mold a young mind in the necessary qualities the society requires of every citizen
especially during the impressionable years of adolescence. Looking at how potent
peer influence is in determining the path adolescents take in life, schools can be
structured to harness this important tool (peer influence) to mold adolescents in the
productive and positive things of life and deter them from the harmful practices like
substance abuse, substance dependency and consequent delinquency. School
programs/activities can be designed to modify the total health of the Nigerian child
putting peer influence into perspective. Dramas, Stage plays, Choreographies, and
other adolescent fun activities could be organized to teach adolescents personal
coping skills, how to say no to social vices and ultimately influence other peers on
living a good life without drugs.
The concept of using peer influence to produce positive developmental benefits in

adolescents as against substance use delinquency in schools can be transferred into the larger
*)

society with the same goal of improving the quality of life of adolescents in Nigeria. The
government and other partners can use a theory-based approach that seeks to understand the
concept of peer influence as it relates to adolescents to design and implement relevant
programs that will be beneficial to adolescents. Local mass media campaigns focusing on
adolescents and community-based movements aimed at sensitizing all stakeholders will go a
long way in effectively communicating the harmful nature of substance use to adolescents,
parents and the society at large; consequently preventing drug abuse amongst Nigerian
adolescents.
Lastly, it is important to consider point-of-sale restrictions within the context of a

comprehensive adolescent drug control policy to prevent indiscriminate access of
adolescents to tobacco, alcohol, sedatives and cough syrups. For illicit substances like
cocaine and cannabis, it is also important for the government through its law enforcement
agencies (NDLEA-National Drug Law Enforcement Agency) to work in partnership with
relevant bodies not only in clamping down on illicit drug barons or raiding drug joints, but
to harness resources and channel them into policies, preventive measures and programs that
will rehabilitate unproductive end users of drugs and consequently reduce the vulnerability
of the Nigerian adolescents to drug abuse.
**

5.0 REFERENCE
CHAPTER ONE
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*+

CHAPTER TWO
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17. Oshikoya K & Alli A 2006. Perception of Drug Abuse Amongst Nigerian
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18. Uberg K, Luo Q, Pilgrim C & Degirmencioglu S 2003, A two-stage model of peer
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May 2013, http://psycnet.apa.org/?fa=main.doiLanding&doi=10.1037/0278-
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*-

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CHAPTER THREE
1. UNODC, Conducting School Surveys On Drug Abuse, pp. 6, 2003, viewed 20 May
2013, http://www.unodc.org/documents/data-and-
analysis/statistics/Drugs/GAP_module_3.pdf
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May 2013, http://www.lagosstate.gov.ng/pagelinks.php?p=6
3. Lagos State List of Schools, 2012. Lagos Eko Project Website, viewed 25 May 2013,
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4. Anderson P, 2006. Global Use of Alcohol, Drugs & Tobacco, Drug & Alcohol Review,
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5. UNODC, 2011. World Drug Report, viewed 26 March 2013,
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analysis/WDR2011/The_cannabis_market.pdf
6. Vittinghof E, McCollof C, 2007. Relaxing the rule of ten events per variable in logistic
and cox regression, viewed 13 August 2013,
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7. WHO, 1980. A Methodology for Student Drug Use Surveys, Student drug use
questionnaire, pp. 35, viewed 1 May 2013,
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8. Dielman T, Campanelli P, Shope J, Butchart A, 1987. Susceptibility to Peer Pressure,
Self Esteem, and Helath Locus of Control as Correlates of Adolescents Substance
Abuse, Health Education Quarterly, vol. 14, pp. 211, viewed 1 May 2013,
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00207.pdf?sequence=2
CHAPTER FOUR
1. WHO, 1980. A Methodology for Student Drug Use Surveys, Student drug use
questionnaire, pp. 35, viewed 1 May 2013,
http://whqlibdoc.who.int/offset/WHO_OFFSET_50.pdf
*/

APPENDIX
APPENDIX A: YOUTH SCHOOL SURVERY
YOUTH SURVEY QUESTIONNAIRE

Young People’s Views, Life Experiences with Peers & Substance Use
This Survey will find out about life experiences of adolescents as it relates to interaction
with peers & substance use. It will help in formulating beneficial programs for youths
Kindly answer the questions honestly as there are no rights or wrong answers. It should take
you about 30 minutes to complete this survey. DO NOT WRITE YOUR NAME PLEASE
because we don’t need your identity in this survey. Your cooperation is highly appreciated.
ABOUT YOU, Please put a cross (X) in the most appropriate box
1 Are you a male or a female? □Male □Female

2 What is your age? □15 □16 □17 □18 □19 □20
3 What class are you? □SS1 □SS2 □SS3
For Every Question, Please Read Parts A, B, C, D And Answer Each Part
4a. Have you ever smoked, chewed or sniffed any tobacco product (such as □No □Yes
cigarettes, cigars, pipe tobacco, chewing tobacco)?
4b. Have you smoked, chewed or sniffed a tobacco product (such as cigarettes, □No □Yes
cigars, pipe tobacco, chewing tobacco) in the past 12 months?
4c. Have you smoked, chewed or sniffed a tobacco product (such as cigarettes, cigars, □No □Yes
pipe tobacco, chewing tobacco) in the past 30 days?
4d. How old were you when you first smoked, chewed or sniffed tobacco? (Age in years)
□I have never smoked, chewed or sniffed a tobacco product
□10 or less □11-12 □13-14 □15-16 □17-18 □19 or more
5a. Have you ever drunk any alcoholic beverage (including beer, wine and spirits) □No □Yes
5b. Have you drunk any alcoholic beverage in the past 12 months? □No □Yes
5c. Have you drunk any alcoholic beverage in the past 30 days?
□ No □ Yes, on 1-5 days □ Yes, on 6-19 days □Yes, 20days or more
5d. How old were you when you first had a drink of beer, wine or spirits-more than just a sip? (Age in years)
□I have never drank alcohol beverage (including beer, wine and spirits)
□10 or less □11-12 □13-14 □15-16 □17-18 □19 or more
6a. Have you ever taken any cannabis (Marijuana, Weed, Igbo, Ganja)? □No □Yes
+&

6b. Have you taken any cannabis during the past 12 months? □No □Yes
6c. Have you taken any cannabis during the past 30 days?
6d. How old were you when you first took cannabis? □I have never taken cannabis (Weed, Igbo, Marijuana)
(Age in years)
□10 or less □11-12 □13-14 □15-16 □17-18 □19 years old, or more
7a. Have you ever taken any cocaine? □No □Yes
7b. Have you ever taken any cocaine in the past 12 months? □No □Yes
7c. Have you ever taken any cocaine in the past 30 days?
7d. How old were you when you first took cocaine? □I have never taken cocaine
(Age in years)
8a. Have you ever taken Codeine (Cough Syrup), Flunitrazepam (Refinol/Rohypnol) □No □Yes
or Sedative (Sleeping pill) without a doctor or health worker telling you to do so?
8b. Have you ever taken Codeine (Cough Syrup), Flunitrazepam (Refinol/Rohypnol) □No □Yes
or Sedative (Sleeping pill) in the past 12 months without a doctor or health worker
telling you to do so?
8c. Have you ever taken Codeine (Cough Syrup), Flunitrazepam (Refinol/Rohypnol)
or Sedative (Sleeping pill) in the past 30 days without a doctor or health worker
telling you to do so?
8d. How old were you when you first took Codeine, Flunitrazepam (Refinol/Rohypnol) or Sedative (Sleeping pill)
without a doctor or health worker telling you to do so? (Age in years)
□I have never taken Codeine, Refinol or Sedative without a doctor telling me to do so?
8e. If you have ever taken sedatives (sleeping pills) write in the name of the one you have taken most recently
(without doctors prescription). ……………………...............................................
9a. Are there any other substances you drink or smoke not mentioned that you have □No □Yes
taken in the past year?
9b. If yes, write in the name of the drug or drugs here………………………..…………………...
10a. Do you know of any other substances that people are now taking to make them □No □Yes
feel high or intoxicated?
10b. If yes, what are these substances called?..............................................................................
11. If you had ever used any cannabis, would you have admitted it □No □Not □Yes
in this questionnaire? sure
+'

ABOUT YOU AND YOUR FRIENDS (CLOSE FRIENDS/ BOY OR GIRLFRIEND)
Please put a cross (X) in the most appropriate box.
1. If your friend offers you a drink of alcohol, would you drink it? □No □Yes
2. If your friend offers you a drink of alcohol, would you want to try it? □No □Yes
3. If you are at a party where your friends are drinking alcohol, would you feel left □No □Yes
out if you are not drinking alcohol?
4. If your friend dares you to smoke a cigarette and your parents don’t want you to □No □Yes
smoke, would you smoke it?
5. If your friend dares you to tear a page out of a school library book, will you do it? □No □Yes
6. If your friends are going to the movies and you have to study for a test, would you □No □Yes
go to the movies anyway?
7. If your best friend is skipping school, would you skip too? □No □Yes
ABOUT BEING TEMPTED

Listed below are situations that lead some people to smoke. We would like to know HOW TEMPTED you may
be to smoke in each situation below. Please put a cross (X) in the most appropriate box.
1:Not at 2:Not 3:Moderately 4:Very 5:Extremely
all very tempted tempted tempted
tempted tempted
1. With friends at a party. □ □ □ □ □
2. When I first get up in the morning. □ □ □ □ □
3. When I am very anxious & stressed. □ □ □ □ □
4. Over lunch when talking & relaxing. □ □ □ □ □
5. When I feel I need inspiration. □ □ □ □ □
6. When I am very angry about something □ □ □ □ □
or someone.
7. With my girl/boy friend or close friend □ □ □ □ □
who is smoking.
8. When I realize I haven't smoked for a □ □ □ □ □
while.
9. When things are not going my way and I □ □ □ □ □
am frustrated.
THANK YOU FOR YOUR PARTICIPATION AND TIME.
+(

APPENDIX B: INFORMATION SHEET/CONSENT FORM
INFORMATION SHEET AND CONSENT FORM
Title of Study: Exploring Peer Influence as a Pathway to Adolescent Substance Use in

Nigeria
Investigator: Alexander Oni, Master of Public Health Student, Hamburg University of

Applied Sciences, Hamburg, Germany.
You are being invited to take part in a research project. Before you decide, it is important for
you to understand what taking part might involve for you. Please take time to read and
discuss this information sheet with others or me if you would like to.
1. Purpose of the study: to find out about adolescents views about substance use.
2. Participants: adolescents in schools voluntarily filling questionnaire forms about their

life experiences as it relates to substance use.
3. Benefits of Participation: the research is not expected to provide any direct benefit to
you, but it is expected that the results will be beneficial to young people in general. This
is because it will provide a better understanding of issues that affect young people.
4. Risk of participation: It is not expected to place you at any risk. If you experience
some discomfort during the session, please let me know and I can stop your survey and
guide you to get support.
+)

STATEMENT OF PERSON OBTAINING INFORMED CONSENT.
I have fully explained this research to______________________________________ and

have given sufficient information, including about risks and benefits, to make an informed
decision.
DATE: ___________________ SIGNATURE__________________________________
NAME___________________________________________________________________
STATEMENT OF PERSON GIVING CONSENT.
I have read the description of the research. I have also talked it over with the doctor to my
satisfaction. I understand that my participation is voluntary. I know enough about the
purpose, methods, risks and benefits of the research study to judge that I want to take part in
it.
DATE: ___________________ SIGNATURE __________________________________
NAME___________________________________________________________________
SIGNATURE OF LEGALLY AUTHORISED REPRESENTATIVE
OF MINOR OR VULNERABLE ADULT_______________________________________
AUTHORITY TO ACT FOR PARTICIPANT____________________________________
WITNESS/TRANSLATOR’S SIGNATURE (if applicable) _________________________
WITNESS’ NAME (if applicable) _____________________________________________
Researcher‘s Contact:
Name: Alexander Oni
Phone: 08037228206
Email: [email protected]
+*

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     

MPH Master Thesis

Supervisor: Prof. Dr. Ralf Reintjes

Department of Public Health

Hamburg, September 2013

To God be the glory, great things He hath done.

DISCUSSION & CONCLUSION

2.0 Background on Peer Influence in Adolescent Substance Use………..……….... 6

4.0 Results and Discussion………………………………………………….………. 26

4.5 Lifetime substance use & peer pressure………………………………… 31

NDLEA National Drug Law Enforcement Agency

In addition to its huge population, Nigeria is endowed with natural resources.

1.2. HISTORY OF DRUG USE IN NIGERIA

1.3. LITERATURE REVIEW ON DEMOGRAPHIC

In a comprehensive review of 28 psychiatric units in health facilities in Nigeria by

In another review of drug abuse patients admitted at Yaba Psychiatric Hospital,

BACKGROUND ON PEER INFLUENCE IN ADOLESCENT SUBSTANCE USE

2.1.1. CONTEXTUAL FACTORS

3. Extreme Economic Deprivation: Although, there is no consistency in relationship

3. Poor and Inconsistent Family Management Practices: Initiation of drug use by

2.2. PEER INFLUENCE

Peer Influence is defined as pressure, planned or unplanned, exerted by peers to

2.2.2. FORMS OF PEER INFLUENCE

Furthermore, in a study on peer influence and selection mechanisms, Ashby and

2.4. LITERATURE REVIEW ON PEER INFLUENCE AND SUBSTANCE USE:

In Nigeria, some relevant studies on peer influence as it relates to substance abuse

Adelekan et al carried out a cross sectional study published in 1993 among

A cross sectional study on the prevalence of psychoactive substance use among

2.5. THEORETICAL CONSIDERATIONS FOR THE STUDY

2.5.1. PEER CLUSTER THEORY (PCT)

TABLE 1: SOURCE: OETTING & BEAUVAIS, 1986.

2.5.2. SOCIAL COGNITIVE THEORY (SCT)

2. Behavioral Capability - This refers to a person's actual ability to perform a behavior

4. Reinforcements - This refers to the internal or external responses to a person's behavior

5. Expectations - This refers to the anticipated consequences of a person's behavior.

FIGURE 1. SOCIAL COGNITIVE THEORY: BANDURA’S CONCEPT

2.7 LITERATURE REVIEW ON PEER INFLUENCE, SELF-EFFICACY AND

2.6 LITERATURE REVIEW ON PEER INFLUENCE, SELF-EFFICACY AND

2.7. STUDY GOAL, RESEARCH OBJECTIVES/QUESTIONS &

TABLE 2. RESEARCH OBJECTIVES AND QUESTIONS

4. Young people feel more comfortable admitting to illegal or socially disapproved

The choice of a cross sectional study is based on the following:

3.4. POPULATION & SAMPLING

To assess self-efficacy as it relates to adolescent substance use, a short version of a

RESULTS AND DISCUSSION

4.1 DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS

FIGURE 2. SEX DISTRIBUTION OF RESPONDENTS

4.2 PREVALENCE OF SUBSTANCE USE AMONG RESPONDENTS

FIGURE 3b. PERCENTAGE DISTRIBUTION OF USERS AND NON-USERS

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'* 0 

FIGURE 6. % OF LIFE TIME USERS THAT ARE CURRENT

4.3 ASSESSMENT OF WILLINGNESS TO DISCLOSE SUBSTANCE USE

FIGURE 7. WILLINGNESS TO DISCLOSE SUBSTANCE USE

100% of 20 years old respondents (2 out of 2) admitted to being susceptible to peer

4.5. LIFE TIME SUBSTANCE USE AND SUSCEPTIBILITY

4.7. TEMPTATION TO SMOKE IN NEGATIVE SITUATIONS

FIGURE 9. TEMPTATION TO SMOKE IN NEGATIVE SITUATIONS

4.8. TEMPTATION TO SMOKE IN HABITUAL AND CRAVING SITUATIONS

0 0

'* 0

DATE: _ SIGNATURE________________

DATE: _ SIGNATURE ________________