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Prevalence and Pattern of Drug Use in Third Year Belize City High School Students 2012-2013

PREVALENCE AND PATTERN OF DRUG USE AMONG THIRD YEAR HIGH SCHOOL

STUDENTS IN BELIZE CITY 2012-2013

J. Briceño-Perriott, PhD, Principal Investigator

Psychologist/Researcher

Fermin Olivera, MSW, Co-Investigator

University of Belize

Esner Vellos, Collaborator

National Drug Abuse Control Counsel

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Acknowledgments

The researchers thank the following:

Belize City High School principals and authorities who granted permission for

participation in the survey

Parents who provided informed consent so their children could participate in the survey

Belize City third year high school students who participated in the study

UB students who helped with the collection of data

Kyle Trujeque, UB, for data entry

Sincere thanks to Esner Vellos, Director of The National Drug Abuse Control Council (NDACC)

and Rebecca Tillett, Ministry of Health for continuous encouragement.

Special thanks to Morales & Co., 3401 Mountain View Boulevard, Belmopan City, for

transportation and use of office space.

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Content

List of Tables v

List of Figures vi

Executive Summary 1

Introduction 3

CHAPTER I. Background

1.1 Theoretical Framework 5

1.2 Current studies-Adolescents and Drug Use 10

1.3 Problem Statement 12

1.3.1 Central Research Questions 13

1.4 Significance 14

CHAPTER 2. Methodology

2.1 Objectives 15

2.1.1 General Objectives 15

2.1.2 Specific Objectives 15

2.2 Methodology

2.2.1 General Aspects 16

2.2.2 Type of Study 16

2.2.3 Subjects 16

2.2.4 Sample Size 16

2.2.5 Inclusion, Exclusion and Elimination criteria

2.2.5.1 Inclusion Criteria 17

2.2.5.2 Exclusion Criteria 17

2.2.5.3 Elimination Criteria 18

2.2.6 Definition of Variables 18

2.2.7 Data Collection 20

2.2.8 Data Collection Tool 20

2.2.9 Data Analysis 21

2.2.10 Ethical Considerations

2.2.10.1 Risks 22

2.2.10.2 Confidentiality 22

2.2.10.3 Limitations 23

CHAPTER 3. Results

3.1 Socio-demographic Characteristics 24

3.2 Licit and Illicit Drug Use

3.2.1 Licit and Illicit Drug Use Prevalence 25

3.2.2 First Ever Drug Use and Average Age of First Drug Use 28

3.3 Cigarettes

3.3.1 Cigarette Use Prevalence 29

3.3.2 Cigarette Use profile 29

3.4 Alcohol

3.4.1 Alcohol Use Prevalence 31

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Content

3.4.2 Alcohol Use Profile 31

3.4.3 Binge Drinking 32

3.4.4 Alcohol Beverage of Choice 33

3.5 Marijuana

3.5.1 Marijuana Use Prevalence 34

3.5.2 Marijuana Use Profile 35

3.6 Cocaine and Crack

3.6.1 Cocaine and Crack Use Prevalence 36

3.6.2 Cocaine Use Profile 37

3.7 Non-Prescription Medication

3.7.1 Tranquilizer and Stimulant Use Prevalence 38

3.7.2 Tranquilizer and Stimulant Use Profile 39

3.8 Inhalants

3.8.1 Inhalant Use Prevalence 40

3.9 Students’ Perception of Licit and Illicit Drugs

3.9.1 Ease of Accessibility to Illicit Drugs 41

3.9.2 Accessibility to Illicit Drugs 42

3.9.3 Curiosity about Illicit Drugs 43

3.9.4 Perceived Heath Risks of Licit and Illicit Drugs 45

3.10 Student Drug Use Predictors

3.10.1 Predictors 46

CHAPTER 4. Discussion, Conclusion and Recommendations

Discussion

4.1.1 Drug Use Prevalence 48

4.1.2 Licit and Illicit Drug Use Pattern 49

4.1.3 Students’ Perception of Licit and Illicit Drug Use Health Risks 52

4.1.4 At Risk factors for Licit ad Illicit Drug Use

Conclusion

Recommendations 54

4.3.1 Research 56

4.3.2 Prevention and Intervention 56

References 58

Appendices

Appendix 1 MOH Human Studies Committee’s Letter of Approval 61

Appendix 2 Parental Informed Consent Letter 62

Appendix 3 Student Informed Consent Letter 63

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List of Tables

2.2.6 Definition of Variables 18

Table 1. Frequency and percentage distribution by male/female demographic characteristics

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Table 2. Belize City Third Year High School Students 2012-2013 Cigarette Smoker Profile

30

Table 3. Belize City Third Year High School Students 2012-2013 Alcohol Use Profile

32

Table 4. Belize City Third Year High School Students 2012-2013 Type of Alcohol Beverage Consumed by Percentage

34

Table 5. Belize City Third Year High School Students 2012-2013 Marijuana Use Profile

36

Table 6. Belize City Third Year High School Students 2012-2013 Cocaine Use Profile

38

Table 7. Belize City Third Year High School Students 2012-2013 Perception of Ease of Access to Illicit Drugs

42

Table 8. Belize City Third Year High School Students 2012-2013 Access to Illicit Drugs

43

Table 9. Belize City Third Year High School Students 2012-2013 Perception of Harmfulness of Licit & Illicit Drugs by Percentage

46

Table 10. Belize City Third Year High School Students 2012-2013 Significant Predictors for Licit and Illicit Drug Use

47

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List of Figures

Figure1. Belize City Third Year High School Students 2012-2013 Lifetime, Past Year and Current Drug Use Prevalence

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Figure 2. Significant Differences in Belize City High School Students 2012-2013 Drug Use Lifetime Prevalence by Sex

27

Figure 3. Belize City Third Year High School Students 2012-2013 Time of First Drug Use

28

Figure 4. Belize City Third Year High School Students 2012-2013 Past and Current Marijuana User Prevalence by Sex

29

Figure 5. Belize City Third Year High School Students 2012-2013 Past Year and Current Alcohol User Prevalence by Sex

31

Figure 6. Belize City Third Year High School Students 2012-2013 Alcohol Use Binge Drinking by Sex

33

Figure 7. Belize City Third Year High School Students 2012-2013 Past Year and Current Marijuana User Prevalence by Sex

35

Figure 8. Belize City Third Year High School Students 2012-2013 Past Year and Current Cocaine and Crack User Prevalence

37

Figure 9. Belize City Third Year High School Students 2012-2013 Past Year and Current Non-Prescribed Medication User prevalence

39

Figure 10. Belize City Third Year High School Students 2012-2013 Reported User Access to Non-Prescribed Medication by Percentage

40

Figure 11. Belize City Third Year High School Students 2012-2013 Past Year and Current Inhalant User by Sex

41

Figure 12. Belize City Third Year High School Students 2012-2013 Curiosity about Taking Illicit Drugs

44

Figure 13. Percentage of Respondents Who Have Consumed Illicit Drugs Within Stated Categories of Would Try, Not Sure If Would Try and Would Not Try If Given Opportunity

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1

Executive Summary

There is a paucity of empirical data on the prevalence and pattern of drug use in Belize

especially in reference to adolescents. Organizations such as the National Drug Abuse Control

Council, the Ministry of Health, Non-Governmental Organizations and School Authorities need

current empirical data to provide effective services to this population. Thus, the general objective

of the current study was to determine the prevalence and pattern of drug use among Belize City

third year high school students. Students in this year fall within the adolescent years as defined

by WHO (1986) and Barker (2003).

This report presents the results of the current study on the prevalence and pattern of drug

use in Belize City third year high school students. Initially the study was designed to include all

Belize City third year high school students. However, not all parents or school authorities gave

informed consent for the students to participate in the study. Of the completed questionnaires

only 422 questionnaires met the inclusion criteria. The average age of participants was 16 years

corresponding to the adolescent period.

The study involved collection of data on the prevalence of licit and illicit drug lifetime,

past year and thirty days use. The licit drugs studied were alcohol and tobacco (measured by

cigarette use) and the illicit drug studied included marijuana, cocaine, crack, inhalants, non-

medical use of prescription drugs and ecstasy. Alcohol was the licit drug with the highest

prevalence and marijuana was the illicit drug of highest prevalence. Gender differences in

frequency of use were found only in four drugs tobacco, marijuana, inhalants and crack. Females

in this sample are more likely to consume inhalants than males while males are more likely to

consume tobacco, marijuana and crack. Students also drink frequently and almost half of the

sample binge drinks. Interestingly, students reported using marijuana more than tobacco lifetime,

past year and current use.

The study’s findings indicate that students use both licit and illicit drugs at their home

and at friends’ homes. They also obtain drugs from friends. Licit drugs are easily obtained from

neighborhood shops and prescription medicine for non-medical use is also obtained from

pharmacies. Average age for first cigarette use is 12.5 years, first alcohol use is 13.2 years and

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for illicit drug use is 13.6 years. However the mode is 14 years which suggests that these

students first drug use occurs in first and second forms.

Results further indicate that students believe they can access illicit drugs fairly easily.

Students also reported being offered to consume or buy marijuana at a higher proportion than

other illicit drugs. Two thirds of the students are of the opinion that they would not try an illicit

drug. However, an analysis of the data indicates that some students who stated they would not try

an illicit drug have indeed done so. Additionally, regardless of the drug involved a majority of

the respondents believe that usage could be moderately harmful or very harmful. Of concern is

the percent of respondents who believe that drug use is harmless or who do not know if drug use

is harmful.

Finally, statistical analyses results determined that the socio-demographic variables: sex,

main residence and family of origin are predictors for first drug use. Thus being male places

respondents at risk for tobacco and marijuana use, being female and living in South side Belize

City places the respondent at risk for inhalant use, being female and living in Belize City

compared to rural Belize places the respondent at risk for inhalant use and being male and living

in an extended or blended family places the respondent at risk for crack use.

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Introduction

Research investigation shows that in the last decades there have been dramatic changes in

the health of youths in the Caribbean, characterized by consequences of high-risk behavior

resulting in greater causes of death and disability during adolescence. These behaviors include

increase in early sexual activity, violence, and drug use.

The problem in Belize and for the remainder of the Caribbean is defined by the influence

of drug trafficking in the region. Belize is a small country with diverse ethnicities bordered on

the east by the Caribbean Sea, on the north by Mexico and on the south and west by Guatemala.

Belize has been considered as having porous borders facilitating illicit drug traffic from South

America to the United States of America.

The result of this drug trafficking has increased the availability of these drugs and the

consequences have been felt in Belize. Thus, it is not amazing that results of investigations show

that in the Caribbean, the number of secondary students that experiment and become involved

with drugs has increased over the last decade.

The population of Belize consists of approximately 157,935 men and 154,763 women of

whom 20% are between the ages of 15 and 20 years. In 2010, 88,000 people were enrolled in

some form of formal education; 17,200 of these persons were attending secondary school. More

males than females study at the primary school level but at the university level the women

surpass the men in a proportion from 1 to 2 (SIB, n.d.). Besides the economic and social factors

that can contribute to this disparity, it is the view of many Belizeans that adolescent males do not

complete formal education due to high drug and alcohol use but there is no recent empirical data

on the prevalence and pattern of drug use in adolescents to corroborate this notion.

Consequently, this research seeks to investigate the prevalence and pattern of drug use

among 3rd

Year students in Belize City for the purpose of obtaining empirical data to formulate

strategies for policy development for the prevention and reduction of drug use among

adolescents.

This project contributes to and supports the development of the Central American

Network of Investigation in Addictions (RECIA), formed as a product of the H90 project of the

United Nations Office against Drug and Crime (ONUDD). The results of this investigation allow

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for comparisons to be made, on prevalence and pattern of drug use among adolescents, in the

Caribbean and other Central American countries. Additionally, this study provides a baseline for

future investigations and for a national study of prevalence and pattern of drug use among

adolescents in Belize.

The report is divided into four chapters. The first chapter develops the theoretical

framework that contextualizes the investigation, describes the problem being addressed, the

research questions, and justification for the study. The second chapter details the study’s

objectives, the design of the study, the location, the target and sample population, the criteria for

inclusion and exclusion, the variables of the study, the procedure for data collection, data

analysis, and ethical considerations. The third chapter delineates the study’s results and the

fourth chapter presents the discussion, conclusion and recommendations. The references and

appendices are annexed at the end of the report.

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CHAPTER 1

Background

1.1 Theoretical Framework

1.1.1 Adolescence

In an effort to explore and gain a better understanding of drug prevalence and drug

consumption patterns among 3rd

year high school students in Belize City, the following

theoretical constructions were used as a framework for the study; Erikson’s Psychosocial

Theory, Social Systems Perspective, Risk Taking Theory based on dispositional traits, Exchange

Theory and Social Control theory.

Barker (2003) stated that while there are variations as to the specifics of the adolescence

period, there is consensus that adolescence is the period between childhood and adulthood—

starting from puberty and ending with young adulthood. The definition of Barker (2003)

coincides with that of the World Health Organization (WHO). WHO (1986) described

adolescence as the transition period between childhood and adulthood characterized by (a)

efforts to reach goals related to the expectations of the dominant culture and (b) by spurts of

social, emotional, and physical development. The start of adolescence is associated with the start

of puberty; the end of the period of adolescence is less defined. Besides, adolescence varies a lot

from culture to culture in regards to achieving adult independence. According to WHO (1986),

this period of development ranges from ten to nineteen years. In Belize third year high school

students are typically between 14 to 16 years old. This age range corresponds with the

adolescence phase as described by Barker (2003) and WHO (1986).

Anna Freud in her seminal paper on adolescence in 1958 delineated adolescence as a

unique period of late childhood, characterized by normative upheaval and turmoil (Mishne,

1986). Psychological reactions to physical changes during this period can pose conflicts

considering that adolescents seemingly seek to conform to their peers. Special areas of interest

for adolescents include body image, self-concept, weight level, weight worries and eating

disorders (Zastro & Kirst-Ashman, 2010). Musse (1988) stated that the heavy one-sided

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involvement of the peer group without a positive relation with parents is one of the strongest

predictors of problem behaviors among youths including drug use and abuse among adolescents.

Erikson’s psychosocial theory consists of eight stages and focuses on how personalities

evolve as a result of the interactions between biologically based maturation and the demands

placed by society (Zastro & Kirst-Ashman, 2007). Further, Erikson’s theory notes that one’s

society makes demands at each stage of development. These demands he calls crises and states

that each crisis will require the individual to adjust in order to overcome the crisis necessary for

normal development.

Adolescence corresponds to stage five, identity versus role confusion, of Erikson’s

theory. Accordingly, the most important task at this stage is the development of a sense of

identity—a sense of ―who am I‖. In this stage, people examine the various roles they play and

integrate these into a perception of self. Role confusion results when the individual has difficulty

coping and adjusting (Zastro & Kirst-Ashman, 2007). This consideration is relevant, given the

converging of various ethnic and culturally diverse students in the classroom. This diversity may

pose additional challenges on the adolescent students and increases the risks for the consumption

of drugs given the need for the establishment of new friendships and relations. As said by Anna

Freud, the early adolescent will face and will have to adjust to new and dynamic social demands

(Mishne, 1986).

McWhirter et al. (2004) posited that the variables putting adolescents at risk for alcohol

and other drug consumption can be clustered into four categories: environmental factors, peer

influences, family influences and personal characteristics. With the exception of the last

category, personal characteristics, which may be pointing to genetic predispositions, all the other

categories can be grouped within a systems framework.

The Social Systems Perspective (SSP) may also be valuable in explaining the importance

of family and peer influences. SSP is comprised of nine assumptions that represent a set of

beliefs about human social life. Assumption three and eight of the SSP respectively state that all

social behavior is purposive and that social relationships is the principal structural unit of all

social systems (Norlin & Chess, 1997). This theory further assumes the existence of general

patterns of behavior exhibited by all social systems—all systems affect and are affected by their

social environments. The industrial revolution encouraged migration, from the rural areas to the

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urban communities, in search for better opportunities in the 1920s. Similarly, the shifting roles

and functions and evolving family constructions amidst cultural diversity may influence the use

of drugs among youths given that many adolescent students have to leave their various towns

and villages to attend high school in Belize City. Having to adjust to a different way of life and

given the general consensus among Belizeans that Belize City is perhaps one of the most violent

and drug infested cities in the country may contribute to adolescent drug use and abuse.

According to Bronfenbrenner’s ecological approach to human development, the family, followed

by friends and school are the most important systems for adolescents, highlighting, that the peer

groups can provide social rewards like status, prestige, popularity and acceptance and these can

serve to positively or negatively influence the adolescent (Musse,1988).

McWhirter et al. (2004) stated that in addition to specific familial patterns in drug taking

adolescents, cultural and sociological factors also contribute to adolescent drug experimentation

and substance abuse. In Belize for example, alcohol consumption in family festivities is a

common occurrence. It is clear that a better understanding of the family systems and the socio-

cultural environment of the Belizean youth may provide possible explanations about the drug

prevalence and pattern of use among high school students.

In the last two decades, starting in the early 80’s, there has been a shift from infectious

diseases to social morbidities, caused by individual risk behaviors and environmental factors,

that heighten threats to especially youthful populations as those found in the Caribbean region

(Blum et al., 2003). In Belize, 20% of population are between15 to 20 years (SIB, n.d.).

The involvement of risk behaviors in the areas of alcohol consumption, marijuana and

cigarette smoking, the early involvement in sexual activity and delinquency among young people

makes adolescent health risk behaviours a global concern especially given the morbidity and

mortality of young people (Ohene, Ireland, & Blum, 2005). Given the youthful population of

Belize, this is of concern to governmental agencies.

Exchange theory can also help us understand possible reasons for drug use and seemingly

wilful participation of adolescents in potentially destructive and risky behaviors. Exchange

theory assumes the notion of profits, which can be implicit or explicit. Profits can mean benefits

or rewards, less costs or punishments. Rewards may be material or symbolic, such as attention,

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affection, or status and there is congruence and consensus among many that these rewards are of

significant importance to adolescents (Robbins, Chatterjee & Canda, 1998).

In Belize, given the converging of various ethnic and culturally diverse students in the

classroom, according to Erikson, the adolescent’s need to establish his/her identity and desire to

be accepted may pose additional challenges on the adolescent students and increase the risk for

the consumption of drugs given the need for the establishment of new friendships.

1.1.2 Adolescence and Drug Use.

Risk-taking theories based on dispositional traits examine the propensity of individuals to

take risks while biological models examine genetic factors, neuroendocrine influences and

pubertal events (Rolison & Scherman, 2003). This offers another dimension that can possibly

shed light on the prevalence and pattern of drug use among Belizean high school students.

Another theory that attempts to explain adolescent drug use is that of sensation seeking.

According to Rolison and Scherman (2003), sensation seeking is an established personality

construct that consists of four dimensions: thrill and adventure seeking, disinhibition,

experience-seeking, and boredom susceptibility. Rolison and Scherman (2003) reported on a

study conducted on the use of cannabis and sensation-seeking among college students and found

that cannabis users scored higher on all four dimensions than nonusers. While this one study

alone may not be conclusive evidence as to genetic predisposition for drug use among

adolescents, it provides an explanation for possible drug use among adolescents.

Marcos, Bahr, and Johnson (2012) further indicate that exchange theory suggests that

adolescents may engage in deviant behaviour in order to be accepted by their reference group.

Central to exchange theory are the notions of cooperation, competition, conflict and coercion for

profits (Robbins, Chatterjee & Canda, 1998). This suggests that the adolescent will be involved

in an active and dynamic milieu of decision making in an effort to attain desirable rewards. As

proposed by Marcos, Bahr and Johnson (2001), the best single predictor of drug use is

association with drug-using friends.

Social control theory as proposed by Travis Hirshi assumes that humans are inherently

antisocial and deviance is the natural state. Further, that human conformity is based on a bond

that develops between the individual and society. This bond consists of four elements;

attachment, commitment, involvement, and belief. For example attachment refers to affective

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ties towards parents, school, and friends. The claim is that adolescents with higher levels of bond

are less prone to deviate from the norms of society (Marcos, Bahr & Johnson, 2001).

Given the rate and propensity of adolescents who experiment with and who take drugs,

social control theory is not too concerned as to why adolescents take drugs but more importantly

why some adolescents do not (Marcos, Bahr & Johnson, 2001). This particular consideration

merits priority given the lack of information on adolescents in Belize; therefore, it can be

hypothesized that some Belizean adolescents do not experiment or take drugs.

While there are pieces of information concerning the early involvement of sexual

activity, marijuana and alcohol use, along with the reporting of rising crime and suicide rates

among youths in the Caribbean region (Blum et al., 2003), there is limited information regarding

the prevalence and drug consumption patterns among high school students in Belize, making this

study particularly important as a first step in understanding the drug phenomenon.

1.1.3 Statistics on Adolescent Drug Use

In the United States (US), ¾ of high school students (75.6% of 10 million) reported

having used at least once in a lifetime psychoactive substances including tobacco,

alcohol, marijuana and cocaine (National Center on Addictions & Substance Abuse,

Columbia University, 2011).

Also in the US, 46.1% of 6.1 million of high school students were actual users of

psychoactive substances (National Center on Addictions & Substance Abuse, Columbia

University, 2011).

In Canada, 7% of youths between the ages of 15 and 24 years used illicit drugs including

cocaine, crack, amphetamines, hallucinogens, heroine, ecstasy (Health Canada, 2011).

In the Caribbean, drug use at least once in a lifetime by adolescents between the ages of

14 and 17 years attending high school include the following:

Alcohol (68.9%), tobacco (25.6%), tranquilizers (2.6%), stimulants (3.27%),

volatile inhalants (13.6%), marijuana (17.3%), cocaine (.91%), crack cocaine

(.77%), and ecstasy (.90%).

It should be emphasized that males consume more drugs than females except

alcohol which females report using more (OAS, 2010).

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It is important to reiterate that in Belize there is little empirical data on adolescent drug

use. The following includes the existing data:

In 1992, 57% of adolescents attending schools reported having used alcohol at

least once in a lifetime (PRIDE, Belize cited in Jernigan, 2001).

In 1992, 10.9% of adolescents attending schools reported using alcohol at least

once weekly (PRIDE, Belize cited in Jernigan, 2001).

In 2003, illicit drug use prevalence once in a lifetime in secondary school students

was 27.5%; the reported prevalence for the year was 18.1% (CICAD, 2003).

In 2008, 1 in 5 students between the ages of 13 and 15 years reported using

tobacco once in a lifetime and 1 in 10 students of the same age range reported

using tobacco within the last month prior to the survey (Emmanuel, 2008).

Since there are no current empirical data, it is an opportune time to conduct a study on the

prevalence and pattern of drug use in adolescent students.

1.2 Current Studies on Adolescent Drug Use

This literature review ends with a synopsis of studies on the prevalence of drug use

among youths in the region and internationally to inform and underscore the significance of the

research on the prevalence of drug use among youths in Belize. Prevalence studies indicate that

significant numbers of Caribbean adolescents are engaged in health compromising behaviors but

how these behaviors relate to each other remains unknown. While research in the United States

has shown that health risk behaviors cluster, the same has not been established for the Caribbean.

Ascertaining this determination would open possibilities for tailored programmes to respond to

the present health issues affecting the youths in the region (Ohen, Ireland, & Blum, 2005).

Blum et al. (2003) assessed adolescent health in the Caribbean and found that a small

percentage of adolescents (1.4%) reported using tobacco. Alcohol was the most commonly used

substance on a monthly or more frequent basis (females, 3.9%; males, 7.9%), followed by

marijuana (females, 1.2%; males, 2.3%) and steroids (females, 1.4%; males, 3.2%). The percent

reporting use of any substances monthly or more often was relatively low (10.6%), with the

highest rates among males and older adolescents. Over a fifth of young people nonetheless

11

reported experiencing problems related to drinking or drug use, most commonly, loss of friends

or the breakup of a relationship.

While adolescent drug use in the United States has fluctuated considerable; the 1960s and

1970s displayed significant increases of drug use followed by a decline in the 1980s and once

again an increase in the 1990s. However drug use among high school seniors has declined

consistently since 1998 but remains a concern in industrialized nations (Zastro & Kirst-Ashman,

2007). Bennett, Miller and Woodall (1999) concluded that among alcohol users, binge drinking

and consequences related to alcohol use are higher in adolescence than in any other

developmental stage.

In Belize, results of a study conducted by the Statistical Institute of Belize (2005) in

which 80,000 inhabitants aged 12–65 years were interviewed showed that the lifetime use of

alcohol overall was 47.3%, and the current use prevalence at 27.1%.Tobacco lifetime use was

25.1% and the current use prevalence at 12.6%. The estimated lifetime prevalence of marijuana

use was 11.7% and the current use prevalence 6.9% overall. About 4% of respondents reported

using tranquilizers (non-prescribed) and 1.6% reported using non-prescribed stimulants. Inhalant

use was reported by 1.4% of respondents as was cocaine use. Less than half of one percent of

respondents reported use of the other indicated illicit drugs.

Emmanuel (2008) conducted a school based survey of students in Std 6, Forms 1, 2, and

3. He found that almost 1 in 5 students used any form of tobacco; 8% of the students smoked

cigarettes; one in 10 students used some other form of tobacco. One quarter of the students lived

in homes where others smoked, and half of the students were exposed to smoke around others

outside of the home; one third of the students had at least one parent who smoked.

A recent study conducted by Briceño-Perriott (2011) on the prevalence and pattern of

drug and alcohol use of the student body of the Faculty of Management and Social Sciences

(FMSS) at the University of Belize (UB) indicated that a majority of the students use alcohol

(83.7%) while marijuana and tobacco are used by almost a quarter of the population (23.3%

marijuana and 21.5% tobacco). Amphetamines are used by 6% of the student population and

three percent or less of the student body used various other substances. Significant differences

were found between males and females. Beer (36.7% males versus 14.9% females) was reported

the drink of choice for males (2 {4, 348} = 21.14, p=000). Similarly mixed drinks (36.8%

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females to 20.3% males) are preferred by the females (2 {5, 348} =13.54, p = .019). Males also

tended to drink much more heavily than females. Substantial percentages of UB FMSS students

reported first using alcohol (49.3%), tobacco (12.3%) and marijuana (12%) when younger than

18 years. Indeed students reported starting using alcohol when in high school (38.4%) and in

primary school (2.3%). Research undertaken in Belize indicates that similarly to what is

occurring globally, Belize has a problem with drug use in its young population with significant

differences by sex.

1.3 Statement of the Problem

A majority of the world population that uses alcohol, gets drunk and is involved in

alcohol use related consequences are adolescents (Bennett, Miller & Woodall, 1999). Therefore,

it is not surprising that some Belizeans declare that drug use and abuse among adolescents is a

silent epidemic that has murdered and continues to murder the young Belizean population.

Unfortunately in Belize, there have not been many research studies conducted on this issue to be

able to discuss this anecdotal affirmation scientifically because in Belize a research culture and

implementation of epidemiological studies has not been developed. The most recent study on the

prevalence of alcohol and drug use on Belize’s adolescent population was conducted in February

2002. The Drug Abuse Control Council (NDACC) supported by the Organization of American

States conducted a national pilot of its Epidemiological Study on the Prevalence of Alcohol and

Marijuana Use in High Schools. The questionnaire was administered to a sample of 1,700 second

and fourth form high school students between the ages of 14 and 16 years old. The results

indicated that 73.6% use alcohol and consume from 1 to 5 alcoholic beverages per day and

22.9% use marijuana.

In 2005, the GENACIS study on alcohol use was conducted. The GENACIS project was

a national study implemented by the Ministry of Health, Pan American Health

Organization/World Health Organization and the Statistical Institute of Belize. This study was

conducted as a response to the Global Status (2004) which determined that the mortality rate of

alcohol use disorders in the world population above 15 years was 6.9% for males and 1.3% for

youths. The GENACIS project provided an epidemiological picture of Belize’s alcohol use, a

13

gender profile of alcohol use and an analysis of the pattern of alcohol use and the cost of the

disease to the country.

Additionally, over the years, a couple of high schools in the country have implemented

small surveys of a selective population of their students during Drug Awareness Week.

Likewise, anecdotal information can be easily accessed from scholars, politicians, youth

organizations, and mainstream activists as the presence and effects of drug use in youths are

quite visible in everyday life. Nonetheless, empirical evidence on drug prevalence and pattern of

use among this age group is unknown.

Thus, the problem in Belize is that current empirical data on the prevalence and pattern of

drug use do not exist. Previous studies have concentrated only on alcohol use and with selective

populations. Indeed although the effects of drug use on Belize’s adolescent population are noted,

the actual prevalence and pattern of drug use among this population is unknown. It is important

to note that in Belize, the third year high school students fall within the 14 to 16 years old age

range, the ages determined as adolescent years for this research study.

The researchers, therefore, seek to answer the following questions:

1.3.1 Central Research Questions

What is the prevalence of licit and illicit drug use among third year Belize City high

school students?

What is the pattern of licit and illicit drug use among third year Belize City high school

students?

What is Belize City third year high school students’ perception of access to illicit drugs?

What is Belize City third year high school students’ perception of health risks as a result

of illicit drugs?

What are predictors of first drug use among third year Belize City high school students?

14

1.4 Significance

It is important to state that empirical studies on adolescent prevalence and pattern of drug

use have not been conducted at the national level or within the last 8 years. The most recent

study on the prevalence and pattern of drug use in adolescents in Belize was conducted in

February 2002 by National Drug Abuse Control Council (NDACC) and funded by the

Organization of American States (OAS). The sample consisted of second and fourth year high

school students. Unfortunately, Belize has no current empirical evidence on the prevalence and

pattern of drug use among adolescents.

Given the circumstances described in 1.3 and in the previous paragraph, it is imperative

to conduct research studies to determine the prevalence and pattern of drug use among

adolescents to keep abreast of the country’s current situation and have empirical evidence to

formulate policy development for both governmental and non-governmental organizations in the

area of drug prevention and drug reduction. Currently, NDACC is working on developing a

comprehensive national drug policy including treatment services for drug demand reduction and

prevention. Thus, this study’s empirical data can be used to support policy development,

sensitize stakeholders and professionals who work with adolescents. This study also forms the

basis for future studies with different populations and a national study on the pattern and

prevalence of alcohol and drug use in third year high school students and a second study with the

target population being adolescents who are not attending high school.

15

Chapter 2

Methodology

2.1 Objectives.

2.1.1 General Objective

To determine the prevalence and pattern of licit and illicit drug use among third year high

school students in Belize City.

2.1.2 Specific Objectives

1. Determine the prevalence of licit and illicit drug use among third year high school

students in Belize City once in a lifetime, in the last year, and in the last thirty days.

2. Identify the prevalence of licit and illicit drug use of students according to the socio-

demographic variable, sex.

3. Determine the age of first licit and illicit drug use of third year high school students in

Belize City.

4. Determine preferred alcoholic drink.

5. Identify drug of first use among third year high school students.

6. Identify the drug of choice among third year Belize City high school students.

7. Identify the frequency (how often) of licit and illicit drug use among third year Belize

City high school students.

8. Indentify main suppliers of licit and illicit drugs to third year Belize City high school

students.

9. Identify main places where third year Belize City high school students consume licit and

illicit drugs.

10. Determine Belize City third year high school students’ perception of access to illicit

drugs.

11. Determine Belize City third year high school students’ perception of harmfulness of illicit

drugs.

12. Identify predictors of first drug use.

16

2.2 Methodology

2.2.1 General Aspects

The study was conducted in Belize City high schools with the third year students as the

target population. Data was collected in the semester following Ministry of Health Human

Studies Committee’s (MOHHSC) approval. High schools in Belize consist of 4 years and are of

three types: public, religious but funded by government and one that is totally private and not

funded by government. There are 12 high schools in Belize City with an average of 3 third year

classrooms with 30 to 35 students per classroom. The total number of these students is

approximately 1,260. See Section 2.2.4 for actual number of respondents.

2.2.2 Type of Study

This current study is descriptive, cross sectional, prospective and observational in nature

as information present in the target population was recorded and measured at one specific point

in time and variables were not manipulated. Additionally, the researchers described

characteristics of the target population and gathered preliminary data to support future research.

Further, this current study was quantitative in design as data collected was quantified and

analyzed numerically (Méndez Ramírez, &Namihira Guerrero, 1997).

2.2.3 Subjects

The population for this study initially was to include all third year students of all Belize

City secondary schools attending classes on the day of the survey as described in Section 2.2.1.

Thus, a census of Belize City third year high school students was to be undertaken.

2.2.4 Current Study’s Sample Size

However, (a) informed consent had to be obtained from principals and other relevant

authorities of the high schools; (b) informed consent had to be obtained from parents as students

were under the age of 18 years; and (c) assent had to be obtained from the students once parents

had given permission for participation based on informed consent.

17

Four high schools did not participate either because relevant authorities refused to grant

informed consent for participation or at time of data collection it was difficult to get informed

consent from parents. Additionally, not all parents from participating high schools gave

permission for their children to participate in the survey and not each student who obtained

permission gave assent to participate in the study. In total 422 completed surveys met the criteria

for inclusion in the current study.

2.2.5 Criteria for inclusion, exclusion and elimination

2.2.5.1 Inclusion Criteria

Third year Belize City high school students from schools which school principals gave

permission for the survey to be conducted.

Third year Belize City high school students of both sexes.

Third year Belize City high school students who were in the age range of 14 to 16 years

when the survey was conducted.

Third year Belize City high school students who attended classes the day the survey was

conducted.

Third year Belize City high school students whose parents gave signed informed consent

to participate in the survey.

Third year Belize City high school students who voluntarily wanted to participate in the

survey and who received permission from parents.

2.2.5.2 Exclusion Criteria

Third year Belize City high school students from schools which principals did not agree

to participate in the survey.

Third year Belize City high school students who fell outside the age range of 14 to 16

years.

Third year Belize City high school students who did not attend classes the day the survey

was conducted.

18

Third year Belize City high school students whose parents did not sign the letter of

informed consent allowing children to participate in the survey.

Third year Belize City high school students who did not wish to participate in the survey

although their parents signed informed consent permission.

2.2.5.3 Elimination Criteria

Third year Belize City high school students who submitted incomplete questionnaires.

Third year Belize City high school students who included information not requested.

Third year Belize City high school students who submitted questionnaire on a different

day to when the survey was conducted or the questionnaire collected.

2.2.6 Definition of Variables

Variable Operational Definition Indicators Measurement Scale

Sociodemographic

characteristics

Social and demographic

characteristics of drug users.

Age Numerical &Ratio: 14-17

Sex Categorical &Nominal: Female, Male.

Ethnic Group Categorical &Nominal: Creole, Garifuna,

Mestizo etc.

Marital status of

students’ parents

Categorical &Nominal: Single, Common

law, Married, Widow (er), Divorced,

Separated, Never Married

Family Type Categorical &Nominal: Single parent,

nuclear, extended, blended

Commute Categorical &Nominal: Yes, No

Residence Type Categorical & Nominal: rural. urban ,

Belize City South side, Belize City North

side

School Type Categorical &Nominal: Public, Private

Quasi Private (Religious)

School location Categorical &Nominal: North side, south

side

Prevalence of drug use Total number of drug users Life time Numerical &Ratio

During the last 12

months

Numerical &Ratio

19

During the last 30

days

Numerical &Ratio

Pattern of drug use A pattern of frequency and

use of psychoactive substances

that may or may not cause

damage to one’s health,

including suppliers and venues

for use

Age of first use Numerical & Ratio

First (initial) drug

used

Categorical &Nominal: tobacco, alcohol,

cocaine, crack, cocaine base, heroin,

ecstasy, methamphetamine, marijuana,

poppers, volatile inhalants,

tranquilizers, hallucinogens, opium,

morphine

Drug of choice

Categorical &Nominal: tobacco,

alcohol, cocaine, crack, cocaine base,

heroin, ecstasy, methamphetamine,

marijuana, poppers, volatile inhalants,

tranquilizers, hallucinogens, opium,

morphine

Frequency of use Ratio:weekly, monthly,yearly

Preferred alcoholic

drink

Nominal: Beer, wine, rum, mixed drink

Drug

suppliers/dealers

Nominal: friends, parents, siblings,

street seller, shop , parents

Venue for doing drugs

Nominal: home ,school, sport event,

social event, friend’s home, street

corner, neighborhood

Accessibility of illicit

drugs

Frequency of perception of

ease of access of obtaining

illicit drugs

How easy Categorical & Nominal: easy, difficult;

impossible

Would take drug Categorical& Nominal: Yes, no, not sure

Curious about drug Categorical& Nominal: Yes, no, not sure

When offered to

buy/consume

Ratio: past month, less than a year,

more than an year, never

Predictors of first drug

use

Socio-demographic variables

that significantly relate to first

drug use in a linear

combination p ≤ .05

Sex, family of origin, main residence, ethnicity

Categorical

20

2.2.7 Data Collection

The researchers sought permission from Belize City secondary school authorities to

conduct the survey.

The researchers obtained approval from the Ministry of Health’s Human Studies

Committee (Appendix 1) to conduct survey.

***Once necessary approvals were obtained the following was implemented:

The researchers conducted an informative meeting with secondary schools’ authorities to

explain the objectives, outcomes, benefits and mechanics of the study. Permission was

obtained to send letters of informed consent to the parents of the Belize City third year

high school students. Before administering the questionnaires, the signed letters of

informed consent were collected to determine which students had been granted

permission by their parents to participate in the survey.

Students who had completed RSCH 4015 (Research Studies for the Social Sciences) were

trained to administer the questionnaire. The questionnaire was completed only by those

students whose parents signed the informed consent letter and who wanted to participate

in the survey. Students who did not want to participate in the survey even though their

parents had given permission were not allowed to participate. Students who participated

were also be given a letter of informed consent.

The completed questionnaires sealed in envelopes were given to the researchers who

ensured that confidentiality was met in the handling of the data.

2.2.8 Data Collecting Tool

The instrument utilized is based on the standardized self-report questionnaire used in the

2007 Guyana secondary schools’ survey. This questionnaire was based on the questionnaire used

by the Sistema Inter-Americano Sobre Consumo de Drogas (SIDUC) that was modified and

translated into English for use in the Caribbean. Permission was obtained from the Inter-

American Drug Observatory (OID) of the Inter-American Drug Control Commission (CICAD),

Organization of American States (OAS) to use and adapt the questionnaire to the Belizean reality

(P. Clarke, Coordinator of Information & Research for the Caribbean, CICAD, personal

communication, June 10, 2011). The following socio-demographic variables were added:

21

ethnicity, geographic location, family of origin, and the option never married to the parents’

marital status item. Questionnaire validity was achieved through consultancy with two experts in

research in the area of drug use research in the Caribbean: one from the Research Institute for

Alcohol and Drugs in the Caribbean and the other from the Inter-American Drug Observatory,

CICAD, OAS.

The questionnaire consisted of the following sections:

Socio-demographic data.

Identification of licit and illicit drug use prevalence once in a lifetime, in the last year,

and in the last thirty days.

Identification of the use of the following drugs: tobacco, alcohol, cocaine, crack, cocaine

paste, heroin, ecstasy, methamphetamine, marijuana, stimulants, volatile inhalants,

tranquilizers, hallucinogens, opium, morphine.

Drug use pattern: for example, age at first use, venues where drugs are used, where drugs

are obtained

Accessibility to illegal drugs

Perception of health risk through drug use

2.2.9 Data Analysis

The statistical software that was used to capture and analyze the data collected from the

Belize City high school third year students’ drug use survey was the Statistical Package for the

Social Sciences 18 (SPSS 18). Descriptive statistics in the form of frequency tables and cross

tabulations, chi square tests and inferential statistics in the form of standard linear regression

tests were used to determine the findings of the current study.

22

2.2.10 Ethical Considerations

Since the target population comprised of minors, permission in the form of informed

consent had to be obtained from parents and the relevant secondary schools authorities before

communicating with the students. Additionally, informed consent forms had to be signed by

parents (Appendix 2) and letters of informed consent (Appendix 3) were given to the students

before the students were allowed to participate in the study. Relevant authorities were provided

with letters of informed consent also. Teachers were not used to administer the questionnaire so

that confidentiality could be maintained.

2.2.10.1 Risks

Although there was no serious risk attached to participation in this study, counseling

services free of cost were made available should any student have felt (a) uncomfortable in

responding to some of the questions due to the sensitivity of the issues being investigated or (b)

emotionally upset and needed help. This was made known to participants and parents. Hence, a

psychologist and social worker were present at time of data collection in case items on the

questionnaire caused emotional reactions. However, participants did not request counseling

services at time of data collection or afterwards.

2.2.10.2 Confidentiality

Data collected was managed in the utmost confidence and has only been used for the

purpose of this study. Once the student completed the questionnaire, the data collector collected

the completed questionnaire, placed it in the manila envelope provided, sealed it and took all

sealed manila envelopes directly to the PI who kept the data secured. The data was only seen by

the investigators and data input person who captured the data in SPSS. Once the data was

analyzed and report written, the questionnaires were destroyed.

23

2.2.10. 3 Limitations

Response Rate- Since not all Belize City High Schools participated in the study,

findings cannot be generalized to all Belize City third year high school students.

Response bias- Using a self-administered questionnaire dealing with sensitive

issues may have caused students not to answer truthfully; therefore, response bias

could not be ruled out.

24

Chapter 3

Results

Results of the Belize City Third Year High School Students 2012-2013 Drug Pattern and

Prevalence Survey are presented in this section. Socio-demographic characteristics of the

Table 1. Frequency and percentage distribution by male/female demographic characteristics

Characteristics

Male (n=203) Female (n=218) Total

fi

% fi

% fi

%

School Type

Public 99 23.5 134 31.8 233 55.3

Denominational 88 20.9 67 15.9 156 36.8

Private 16 3.8 17 4.0 33 7.8

Total 203 48.2 218 51.8 421 100

Average Age

Average Age 16.14 16.02 16.08

Ethnicity

Black/African 16 3.8 9 2.1 25 6.0

Creole 102 24.3 115 27.4 217 51.7

East Indian 13 3.1 15 3.6 28 6.7

Garifuna 10 2.4 19 4.5 29 6.9

Mestizo 16 3.8 23 5.5 39 9.3

Spanish 18 4.3 17 4.1 35 8.4

Other 28 6.7 18 4.3 46 11.0

Total 203 48.4 216 51.6 419 100

Family Type

Single Parent 100 24.4 107 26.2 207 50.6

Nuclear 53 13.0 59 13.7 109 26.7

Extended 20 4.9 21 5.1 41 10.0

Blended 23 5.6 21 5.1 44 10.8

Other 4 1.0 4 1.0 8 2.0

Total 203 48.9 209 51.1 409 100

Residency

North Side Belize City 63 15.7 71 19.7 134 33.3

South Side Belize City 81 20.1 93 23.1 174 43.2

Rural Belize District 36 9.0 29 7.2 65 16.2

Urban Out District 6 1.5 5 1.2 11 2.7

Rural Out District 8 2.0 10 2.5 18 4.5

Total 194 48.3 208 51.7 402 100

Source: Belize City Third Year Secondary School Student Survey: Prevalence and Pattern of Drug Use 2012-2013.

N varies because some respondents did not respond to all questionnaire items. One participant did not include sex and is not

included in this table.

25

respondents, lifetime, past month and current drug prevalence, pattern and predictors for licit and

illicit drug use are detailed.

3.1 Socio-demographic Characteristics

As mentioned in Chapter 2, four hundred and twenty two (422) completed questionnaires

met the inclusion criteria for the current study. More than half the questionnaires (55.3%) were

completed by third year public high school students, a little above a third (36.8%) were

completed by third year denominational high school students and 7.8% by private school third

year high school students. There was no significant difference in numbers of students completing

the questionnaire by sex as 51.8% were females and 48.2 % were males. The average age of the

respondent was 16 .08 years with the male average a little above this mean (16. 14 years) and

females below the mean (16.02 years). This mean age corresponds with the expected age of third

year high school students. The majority of respondents identified themselves as Creole. The

reported ethnicities in the other category (11.0%) included mixed ethnicities, Maya Mopan,

Maya Kechi, Chinese and Caucasian/White (Table 1).

The majority of respondents (50.6%) reported living in single parent family households

headed by a mother (65.2%), however; 16.9% of the single parent family households were also

headed by a father. The remaining single parent families were headed by grandparents, siblings,

relatives, guardians or family friends. The percentages of family types reported by male and

female respondents were almost the same (Table 1). Further, the majority of respondents live in

the Belize City South Side (43.3%). A small percentage lives in rural areas (20.7%).

3.2 Licit and Illicit Drug Use

3.2.1 Licit and Illicit Overall Drug Use Prevalence

Figure 1 shows the licit and illicit lifetime, past year and current drug use prevalence.

Alcohol was the drug with the highest prevalence: Lifetime (76.4%), past year (57.1%), and

current (41%). The illicit drug marijuana had the second highest reported prevalence: Lifetime

(35.1%), past year (26.3%), and current (19%). Reported marijuana prevalence was higher than

tobacco prevalence in all three categories. Further, it was also the illicit drug of highest

26

prevalence in all three categories. Reported inhalant use lifetime prevalence was 16.1%, with

12.8% past year prevalence and 9.5% current prevalence. Other illicit drugs used by student

respondents included cocaine, crack, tranquilizers and stimulants (without prescription), and

ecstasy (Figure 1). Reported prevalence for these substances ranged from 4 % to 9% lifetime,

1.6% to 8.5% past year and .5% to 5.4%.

27

Reported prevalence decreased from lifetime to past year to current in all licit and illicit

drug use. Alcohol prevalence saw the highest overall decrease in all categories, followed by

tobacco use and marijuana. This may suggest experimentation by almost 10% of the students in

all three drug use. Stimulants, tranquilizers, inhalants and crack prevalence remained constant in

all three categories indicating that once these drugs are used, the user continues with use as the

drug of choice (Figure1).

Additionally, statistical significant differences in use by sex were found in lifetime

prevalence for four drugs, one licit and three illicit (Figure 2). As detailed in Chapter 2, tobacco

use in this study is measured by cigarette smoking. Indeed, Chi Square Test results indicate that

Belize City Third Year High School 2012- 2013 male respondents were more likely to have ever

smoked cigarettes or marijuana and used crack than female third year high school respondents.

However, it is the Belize City Third Year High School female respondent who is more likely to

Drug

Values

X²

df P ≤ .05

Tobacco 5.676 1 .017

Marijuana 11.012 1 .001

Inhalants 3.795 1 .051

Crack 5.010 1 .025

28

have ever used inhalants compared to the Belize City third year high school 2012-2013 male

respondent (Figure 2).

3.2.2 First Overall Drug Use and Average Age of First Drug Use

Figure 3 indicates the time span in which the student participants first used licit or illicit

drugs. With the exception of alcohol, crack and stimulants, the majority of respondents (49% to

69.5%) indicated that first drug use was more than a year ago. Indeed the average age for first

illicit drug use was 13.6 years with a mode of 14 years. Alcohol and cigarette use are reported

separately. Alcohol, crack and stimulant first use seemed to have occurred in the same proportion

more than a year ago or more than a month ago but less than a year ago.

29

Licit Drugs1

3.3 Cigarettes

3.3.1 Cigarette Use Prevalence

In the current study students who reported smoking were asked whether they had smoked

cigarettes in the past year or in the past thirty days. Figure 4 shows that of those admitting to

smoking cigarettes approximately one third (33.1%) reported currently smoking compared to

41.8% who smoked in the last year but were not currently smoking. Males reported higher

cigarette use than females both in the past year and currently (Figure 4).

3.3.2 Cigarette Use Profile

Mean age of first cigarette use was 12.5 years. Females reported starting smoking later

than their male counterparts approximately about a year and a half later. Females also reported

smoking fewer cigarettes in the past month compared to males. Overall students, who admitted

1 Percentages detailed on pages 29 through 34 refer to those taking licit drugs, not to the study’s entire population.

30

to smoking cigarettes, smoke between 1 to 5 cigarettes per month (75%). Cigarette smoking

occurs mainly in the student’s home (28.6%) or friend’s house (25%). A small percentage (4.8%)

of males admitted to smoking at school. Almost half (49.4%) obtained cigarettes from stores and

29% from friends (Table 2).

Table 2. Belize City Third Year High School Students 2012-2013 Cigarette

Smoker Profile

Characteristics Male Female Total

% % %

Age at First Use

Mean 11.5 13 12.5

Mode 13.8 15 15

Number of Cigarettes Smoked in the Past Month

1 to 5 41.1 33.9 75.0

6 to10 11.8 1.8 8.9

11-20 11.8 1.8 8.9

More than 20 8.8 1.8 7.1

Total 60.7 39.3 100

Venue for Smoking Cigarettes

Home 11.9 16.7 28.6

School 4.8 0.0 4.8

Street Corner/Block 9.5 3.6 13.1

Friend’s House 15.5 9.5 25.0

Social Events 6.0 6.0 11.9

Other 8.3 8.3 16.7

Total 56.0 44.0 100

Cigarette Providers

Friend 15.7 13.3 29

Parent 1.2 0.0 1.2

Sibling 1.2 0.0 1.2

Relative 3.6 3.6 7.2

Street Vendor 2.4 1.2 3.6

Shop 27.7 21.7 49.4

Other 3.6 4.8 8.4

Total 55.4 44.6 100


31

3.4 Alcohol

3.4.1 Alcohol Use Prevalence

Alcohol use prevalence among students who admitted to using alcohol is higher in the

past month (76.3%) than currently (58.4%). Similarly to cigarette prevalence, males have higher

reported alcohol prevalence than females both in the past year and in the last 30 days (Figure 5).

3.4.2 Alcohol Use Profile

Mean age of first alcohol use was 13.2 years. Females reported starting drinking later

than their male counterparts approximately about a year later. Females also reported getting

drunk in the past month fewer times than males. Overall students admitted to getting drunk

approximately 4 times per month with females getting drunk fewer times than males. Alcohol

use occurs mainly in the student’s home (27.1%), a friend’s house (27.5%) or at social events

(25.5%). Only 2 students admitted to drinking alcohol at school. Almost half (43.5%) obtained

32

alcohol from friends and 28.2% reported purchasing alcohol from stores (Table 3). Significant

differences between the sexes were not found.

Table 3. Belize City Third Year High School Students 2012-2013 Alcohol

Use Profile


% % %

Age at First Use

Mean 12.8 13.5 13.2

Mode 14 15 15

Number of Days Gotten Drunk in Past Month

Mean 5.52 3.06 4.37

Mode 2.50 1 2

Venue for Alcohol Use

Home 9.2 17.9 27.1

School 0.4 0.4 0.8



Sporting Event 1.6 0.8 2.4


Other 5.6 4.4 10.0

Total 47.8 52.2 100

Alcohol Providers

Friend 21.4 22.2 43.5

Parent 2.4 3.2 5.6

Sibling 1.2 1.6 2.8

Relative 2.8 8.5 11.3

Street Vendor 1.2 0.8 2.0

Shop 16.5 11.7 28.2

Other 2.0 4.4 6.5

Total 47.6 52.4 100


3.4.3 Binge Drinking

Binge drinking in this study as detailed in Chapter 2 was defined as five (5) or more

alcoholic drinks of any type at one sitting on a single day in the past two weeks to the survey

being implemented. Binge drinking among current alcohol users is high as almost half of the

students (46%) who admitted drinking alcohol admitted to this behavior. Twenty four point one

percent (24.1%) of males and 21.9% of females admitted to binge drinking by the study’s

33

definition. More females than males admitted to binge drinking once in the two weeks preceding

the survey. Males admitted to binge drinking more times than females in the two weeks

preceding the survey [between 4 to 5 plus times] ( Figure 6). However, Chi square test results (χ2

[1, 291] = 6.100, p = 1.92) indicate that both sexes are likely to binge drink.

3.4.4 Alcoholic Beverage of Choice

Respondents further indicated that their alcohol beverage of choice was mixed drinks

with 77.6% reporting consuming the same either daily (4.6%), weekends (20%), some weekdays

(12.9%), and at social events (40%). The second choice of hard liquor (rum) was reported by

71.8% of the respondents. Wine was reported by about two thirds of the respondents and almost

half reported using beer/guinness (Table 4). Statistical differences by sex in the type of alcoholic

beverages consumed and when consumed were not found except for the beer/guinness category

34

with males more likely to consume beer/guinness and on a more frequent basis than females (χ2

[4, 247] = 15.247, p = .004).

Of note is that the majority of the respondents partook of alcoholic beverages at social

events. Of concern is the percentage of respondents who reported drinking on a daily basis:

beer/guinness (4.3%), wine (4%), hard liquor (4.6%), and mixed drinks (4.6%).

Table 4. Belize City Third Year High School Students 2012-2013 Type of

Alcohol Beverage Consumed by Percentage

Alcoholic Beverage

Consumed

Daily Weekends Some

Weekdays

Social Events Never

% % % % %

Beer/Guinness 4.3 14.9 5.8 22.8 52.2

Wine 4.0 10.9 11.6 38.0 35.5

Hard Liquor 4.6 18.7 10.6 37.8 28.3

Shandy 1.9 5.6 5.2 14.1 73.3

Mixed Drinks 4.6 20.0 12.9 40.7 21.8


Illicit Drugs2

3.5 Marijuana

3.5.1 Marijuana Use Prevalence

Marijuana use prevalence among students who admitted to using marijuana, similarly to

alcohol, use is higher in the past year (69.4%) than currently (54.4%). Like cigarette and alcohol

prevalence, males have higher reported marijuana prevalence both in the past year and in the last

30 days (Figure 7).

2 Percentages detailed on pages 34 through 41 refer to those taking illicit drugs, not to the study’s entire population.

35

3.5.2 Marijuana Use Profile

Respondents reported frequency of marijuana use at approximately the same rate (one

fifth) for each of the following categories: only once, sometimes in the past month, sometimes

during the past month, sometime during the week and daily. Of concern is the 20% that reported

daily use. Overall males admitted to using marijuana in each of the categories at a higher rate

than females except in the only once category. Venues for smoking marijuana are similar to

those reported for alcohol use with using at a friend’s home being the highest reported venue

(44.1%), followed by using in the home (21.75). Only 2.1% admitted to using marijuana at

school. Almost half (49.6%) obtained marijuana from friends and 20.9% reported purchasing

marijuana from street pushers (Table 5).

36

Table 5. Belize City Third Year High School Students 2012-2013

Marijuana Use Profile


% % %

Frequency of Marijuana Use

Only Once 7.9 10.7 18.6

Sometimes in Past 12 Months 10.0 9.3 19.3

Sometimes during Past Month 13.6 6.4 20.0

Sometimes During Week 13.6 8.6 22.1

Daily 13.6 6.4 20.0

Total 58.6 41.4 100

Venue for Smoking Marijuana

Home 11.9 9.8 21.7

School 1.4 .7 2.1



Sporting Events 1.4 0.0 1.4


Other 13.3 3.5 16.8

Total 63.3 36.4 100

Marijuana Providers

Friend 28.7 20.9 49.6

Parent .8 .8 1.6

Sibling 1.6 3.1 4.7

Relative 2.3 1.6 3.9

Street Pusher 16.3 4.7 20.9

Other 12.4 7.0 19.4

Total 62 38 100


3.6 Cocaine and Crack

3.6.1 Cocaine and Crack Use Prevalence

Two thirds of the students who reported using cocaine admitted to its use in the past year

compared to 43.8% using in the past month. Similarly crack use in the past year (55.5%) was

higher than current use (22.2%). Of note is that the pattern of use by sex for crack follows that

established for licit drugs with male students admitting to using at a higher percentage both in the

past year and in the last 30 days. Indeed, not one female admitted to using crack currently.

However, the pattern for reported cocaine by sex is different: both male and female students who

admitted to cocaine use reported using cocaine equally (33.3%) in the past year but more female

37

students reported using cocaine currently (31.3%) compared to 12.5% for male students (Figure

8). Indeed, results of Chi square test of significance (χ2 [1, 16] = 3.874, p = .049) indicate that

female cocaine users in the sample are more likely to use cocaine currently than their male peers.

3.6.2 Cocaine Use Profile

More female compared to male cocaine users reported using the illicit drug more

frequently during the past month (female: 20%; male: 13.3%) and during the week (female:

6.7%; male: 0%) reiterating the findings detailed in Figure 8. Unlike previously reported for

alcohol, tobacco, and marijuana, more than half the cocaine users (59.1%) in the sample ticked

the ―other‖ box as the venue for using cocaine. Unfortunately, none indicated what ―other‖

meant. However, as admitted for alcohol, tobacco and marijuana, the second most common

venue for cocaine use reported was at a friend’s house (18.2% of cocaine users) followed by the

home (9.1%). Of note is that the reported 9.1% of cocaine users who reported using in the home

are female. When asked where they obtained the cocaine, the majority (54.2%) again chose the

―other‖ box and did not indicate who the provider was. Of those users who identified the

providers, 33.3% indicated friends and 8.3% pushers. Notably, 4.2% indicated parents as the

38

cocaine provider (Table 6). Further analysis revealed that 7.5% of respondents admitting to

using cocaine live in extended families and 4.5 % live in blended families.


Cocaine Use Profile


% % %

Frequency of Cocaine Use

Only Once 20.0 13.3 33.3

Sometimes in Past 12 Months 26.7 0.0 26.7

Sometimes during Past Month 13.3 20 33.3

Sometimes During Week 0.0 6.7 6.7

Total 60.0 40.0 100

Venue for Cocaine Use

Home 0.0 9.1 9.1



Other 50.0 9.1 59.1

Total 68.2 31.8 100

Cocaine Providers

Friend 20.8 12.5 33.3

Parent 0.0 4.2 4.2

Street Pusher 4.2 4.2 8.3

Other 37.5 16.7 54.2

Total 62.5 37.5 100


3.7 Non-Medical Use of Prescription Medication (Tranquilizers

and Stimulants)

3.7.1 Non-Prescribed Tranquilizer and Stimulant Use Prevalence

Non-prescribed medication (tranquilizers and stimulants) user prevalence both in the past

year and current use was higher in females than males (Figure 9). Although female user

prevalence was higher, it was the male user rather than the female user who reported using

prescription medication for non-medical use on more days of the month. The average number of

non-medical use in the last 30 days reported by tranquilizer users was 8.43 days with male users

reporting above the mean (9.17 days) and female users below the mean (7.88 days). The same

39

held true for stimulant use with a monthly mean of 7.5 days of use. Male users mean was 9.8

days and female users 5.2 days in the last 30 days.

3.7.2 Tranquilizer and Stimulant Use Profile

Figure 10 indicates that access to prescription medication for non-medical use is fairly

easy. Only about 10% of users reported obtaining prescriptions for tranquilizers (10.3%) and

stimulants (8.3%) from doctors. The remaining accessed without prescription. Of importance is

that a third of the users reported accessing stimulants from a pharmacy while 20.7% access

tranquilizers in the home. About 10% obtained these medications from friends while 13.8%

reported getting tranquilizers from pushers and 8.3% reported the same for stimulants. A third

chose the other category but did not elaborate.

40

3.8 Inhalants

3.8.1 Inhalant Use Prevalence

Inhalant use prevalence for students who participated in this study is different than that of

other drugs as females reported a higher past 12 months prevalence rate (33.7%) compared to

males (23.2%) and a higher current prevalence rate (26.2%) than males (23.85%). However, the

pattern for past year and current user prevalence remains the same as for other drugs with past

year prevalence rate (56.9%) higher than the current prevalence rate (50%). Of significance is

that almost half of declared users are currently using and have used in the past year (Figure 11).

Of these 11.4% reported using on a daily basis and similarly 11.4% reported using during the

week.

41

Students’ Perception of Illicit Drugs

3.9 Perception of Illicit Drugs

3.9.1 Ease of Accessibility to Illicit Drugs

Students were also asked how easily they could access illicit drugs. More than half the

students (55.7%) perceived that they could access marijuana far easier than other illicit drugs

[cocaine-15.4%; cocaine paste-15.4%; crack-20.9%] (Table 7). A percentage of respondents who

indicated that illicit drugs are easily obtained have indeed consumed illicit drugs. Of the 55.7%

who thought that marijuana is easy to obtain 50.4% have consumed marijuana. The percentage

decreases for other illicit drugs: 10% of the 15.4% who believe cocaine is easily obtained and

42

8.2% of the 20.9% who believe that crack is easily obtained have indeed consumed the

respective drug. Of importance is that 27.3% of the 8% who stated it would be difficult to obtain

marijuana have indeed consumed the drug and 3.4% of those who reported that they do not know

how to obtain the drug have taken marijuana. The same pattern exists for cocaine and crack but

in far smaller percentages. This may indicate that students do know how difficult it is to obtain

illicit drugs as although they reported difficult to obtain, some have nevertheless obtained the

drug of choice.

Table 7. Belize City Third Year High School Students 2012-2013 Perception of Ease

of Access to Illicit Drugs.

Illicit Drug

Easy Difficult Impossible to obtain Don’t Know Tota

l

% % % % %

Marijuana 55.7 8.0 7.5 28.8 100

Cocaine 15.4 19.8 15.2 49.6 100

Cocaine Paste 10.0 11.7 14.7 63.6 100

Crack 20.9 13.3 16.2 48.6 100

Source: Belize City Third Year Secondary School Student Survey: Prevalence and Pattern of Drug Use 2012-2013 N=409

3.9.2 Accessibility to Illicit Drugs

Two items were used to capture students’ perception of ease of availability of illicit

drugs. Students were asked whether they were offered to buy or consume illicit drugs. Each item

provided four choices as depicted in Table 8. Students reported being offered to consume

(50.8%) or buy (37.6%) marijuana at a higher proportion than other illicit drugs: cocaine (offered

to consume [8.2], offered to buy [7.8%]), ecstasy (offered to consume [10.1%], offered to buy

[8%]), crack (offered to consume [6.2%], offered to buy [5.6%]). Similarly a higher proportion

of students reported being offered to consume and buy marijuana, cocaine, crack and ecstasy in

the month previous to the data being collected than either in the year or more than a year

previous to the data being collected (Table 8).

43


Access to Illicit Drugs.

Illicit Drug

Offered to

Consume

Offered to

Buy

% %

Marijuana

During the last 30 days 28.7 22.7

More than a month ago but less than a year ago 10.6 9.2

More than a year ago 11.5 5.7

Never been offered 49.2 62.3

Cocaine





Ecstasy





Crack



More than a year ago 1.0 .8


Source: Belize City Third Year Secondary School Student Survey: Prevalence and Pattern of Drug Use

2012-2013. N=422

3.9.3 Curiosity about Illicit Drugs

To investigate students’ curiosity and perception of whether they would act on

this curiosity if the opportunity arose two items were used. Each of the items afforded students

three choices. Students could respond negatively, positively or indecisive (not sure).

Approximately two thirds of third year students are of the opinion that they would not try an

illicit drug if offered (66.9%). About a similar percentage (61.2%) reported not being curious

about illicit drugs. Further, 10.5% would try an illicit drug if the opportunity arose and 19.7%

admitted to being curious about illicit drugs. However, 22.6% were of the opinion that they were

not sure if they would try an illicit drug if the opportunity arose. Thus approximately 1 in 3 third

year students were of the opinion that they would try an illicit drug (Figure 12).

44

Indeed further analysis indicated that some of the students who stated they would try or

were not sure if they would try an illicit drug given the opportunity have indeed tried an illicit

drug. Students, therefore, are saying one thing and doing another. Of these, a higher proportion

has consumed marijuana compared to other illicit drugs. Of the students who were of the opinion

that they would not try an illicit drug if given the opportunity, 16.1% reported consuming

marijuana, 10.2% of those who stated they were not sure have consumed marijuana and 6.8% of

those who stated they would try and illicit drug given the chance have indeed consumed

marijuana The proportion of those who admitted consuming other illicit drugs in the three

categories used to investigate curiosity and taking the opportunity to consume illicit drugs is

much smaller than that for marijuana (Figure 13).

45

3.9.4 Perceived Health Risk of Licit and Illicit Drugs

Regardless of the drug involved, a majority of third year students believe that usage could

be moderately harmful or very harmful. The percentage with this belief increased as the

frequency of usage increased from sometimes to frequently. However, 20% of third year students

reported not knowing whether abuse of inhalants, tranquilizers, stimulants and ecstasy was

harmful and 10% did not know that alcohol or cigarette usage was harmful. Additionally 3% to

10% also are of the opinion that any drug use is harmless. Therefore about 23 to 30% of students

believe that drug use is harmless (Table 9). This is an important statistic for prevention personnel

as this may increase the students’ inclination for use and therefore place their health at risk.

46

Table 9. Belize City Third Year High School Students 2012-2013 Perception of Harmfulness of

Licit & Illicit Drugs by Percentage. Not

Harmfu

l

Slightly

Harmfu

l

Moderately

Harmful

Very

Harmfu

l

Don’t

Know

Smoking cigarettes sometimes 7.0 22.8 23.7 34.7 11.8

Smoking cigarettes frequently 4.3 4.3 12.0 68.8 10.6

Drinking alcoholic beverages frequently 8.2 15.3 18.2 50.8 7.4

Getting drunk 4.8 10.1 14.7 61.1 9.2

*Taking tranquilizers/stimulants sometimes 3.6 7.0 22.2 47.6 19.6

*Taking tranquilizers/stimulants frequently 3.1 3.1 10.8 64.3 18.6

Inhaling solvents sometimes 3.9 12.3 29.6 35.6 18.6

Inhaling solvents frequently 3.6 5.8 15.0 57.4 18.2

Smoking marijuana sometimes 17.3 18.3 27.0 28.7 8.7

Smoking marijuana frequently 9.9 12.2 16.8 51.7 9.4

Consuming cocaine sometimes 3.1 4.6 19.3 60.4 12.6

Consuming cocaine frequently 2.4 1.4 8.0 74.9 13.3

Consuming crack sometimes 2.7 2.7 16.7 65.9 12.0

Consuming crack frequently 3.1 1.4 5.8 74.9 14.7

Consuming ecstasy sometimes 5.8 9.9 22.7 42.5 19.1

Inhaling second hand cigarette smoke 3.3 19.1 16.7 53.9 7.0

Inhaling second hand marijuana smoke 9.4 17.5 16.8 47.8 8.4 Source: Belize City Third Year Secondary School Student Survey: Prevalence and Pattern of Drug Use 2012-2013. N=422 *= without medical prescription

Student Drug Use Predictors

3.10 Predictors

Standard multiple regressions were conducted to evaluate how well main residence,

ethnicity, sex and family of origin predicted lifetime use of the following: tobacco (cigarette),

alcohol, marijuana, non-prescription medication (tranquilizers and stimulants), inhalants, cocaine

and/or crack. None of the variables were found to be predictors of alcohol, prescription

medication for non-medical use and cocaine use.

However, tobacco (cigarette), marijuana, inhalant and crack use did have significant

predictors. Sex was significantly related to lifetime cigarette use (F [4, 386] = 1.508, p = .05. Sex

was also significantly related to lifetime marijuana use (F [4, 386] = 4.036, p = .003. The linear

combination of sex and main residence (F [4, 386] = 3.343, p = .01 was also significantly related

to lifetime inhalant use. The linear combination of sex and family of origin (F [4, 386] = 2.587, p

= .04) was significantly related to lifetime crack use (Table 10).

47

Table 10. Belize City Third Year High School Students 2012-2013 Significant Predictors for

Licit and Illicit Drug Use

Results of the standard multiple regression tests support the findings of the univariate

tests depicted in Figure 2. As depicted in Figure 2 and confirmed by the multiple regression tests,

being male is a predictor for ever using cigarettes, marijuana or crack. It is the female student

who is susceptible to ever trying inhalants. Further analyses indicated that living in the Southside

of Belize City compared to the north side is also a predictor for trying inhalants. Also it is more

likely that third year Belize City high school female students would try inhalants compared to

rural Belize or urban out district third year high school Belize City female students. Further the

extended family and blended family are the family types that are predictors for crack use.

Therefore if the student’s family of origin is either extended or blended and the student is male,

he is at risk for trying crack. If the Belize City third year high school student is female and living

in Belize City specifically the Southside, she is at risk for using inhalants.

Drug of Choice

Values

Predictors

F

df P ≤ .05

Tobacco (Cigarette) 1.508 4 .05 Sex

Marijuana 4.037 4 .003 Sex

Inhalants 3.343 4 .01 Sex, Main Residence

Crack 2.587 4 .04 Sex, Family of Origin

48

CHAPTER 4

Discussion, Conclusion and Recommendations

Discussion

4.1.1 Prevalence

As stated in Chapter 2 under Section 2.2.10.3, one of the major limitations of the study is

the response rate. Secondly, using a self-report questionnaire dealing with sensitive issues,

response bias could not be ruled out. However, response rate would not have been different

given that a substantial number of the sample population required parental informed consent and

school authorities’ permission to participate. Although, the findings cannot be generalized to all

third year high school students, the current study has obtained valuable baseline data on a very

sensitive area: prevalence and pattern of licit and illicit drug use among third year Belize City

students.

Lifetime prevalence was highest for alcohol (76.4%) followed by marijuana (35.1%).

Marijuana had higher lifetime prevalence than tobacco (28.3%). Marijuana also had the highest

lifetime prevalence among illicit drugs, followed by inhalants (16.1%), ecstasy (6.4%),

tranquilizers (4.7%), stimulants (4.5%), cocaine (4%), and crack (1.9%). A proportion of third

year Belize City students indicated having taken other illicit drugs than the choices given in the

questionnaires but did not expound.

In this study lifetime prevalence refers to ever using a drug, past year to using within

twelve months of completing the questionnaire and current prevalence refers to using within 30

days of completing the questionnaire. In both licit and illicit drug categories reported prevalence

decreased from lifetime to past year to current use; for example, alcohol prevalence decreased

from 76.4% (lifetime) to 57.1% (past year) 41% (current). The same pattern held for marijuana

which prevalence went from 35.1% (lifetime) to 26.3% (past year) to 19% (current). Although

crack, cocaine, tranquilizer, stimulant, ecstasy and inhalant use decreased also from lifetime to

past year to current use the percentage difference was very small suggesting that once the

respondents started using either of these drugs, he/she continued with use as drug of choice. The

larger difference in lifetime, past year and current prevalence in alcohol use, marijuana use and

49

tobacco (cigarette) use suggests experimentation with these drugs by the respondents. Higher

alcohol prevalence in all three categories also suggests that alcohol is the first drug of choice of

the respondents. Indeed this finding may possibly reflect the familial, cultural, and sociological

manifestation of alcohol consumption that exists as postulated by McWhirter et al. (2004). In

Belize, alcohol is regarded as a rite of passage for teenagers and is served at family and social

events at which children and teenagers are present. Alcohol then becomes the norm.

The use of inhalants is of note and may well be the first empirical reported findings for

Belize. With16.1% reported once in a lifetime use, the consumption pattern resembles that of

marijuana use. A little more than 50 % who tried inhalants reported using within the last 30 days.

All other listed illicit drugs; cocaine, crack, tranquilizers, stimulants, and others were reportedly

being used by students less prevalently.

Of concern is that the once in a lifetime prevalence rate for the licit and illicit drugs

investigated in this study is higher than that found for the Caribbean by OAS (2010) for

adolescents between the ages of 14 and 17 years attending high school (alcohol 76.4% compared

to 68.9%; tobacco 28.3 % compared to 25.6%; tranquilizers 4.7% compared to 2.6%; stimulants

4.5% compared to 3.3%; inhalants16.1% compared to 13.6%; cocaine 4% compared to 1%;

crack 1.9% compared to .8% and ecstasy 6.4% compared to .9%). According to Jernigan (2001)

in 1992, 57% of students reported having used alcohol at least once in a lifetime. Twenty years

later, almost 80% of third year high school students reported using alcohol at least once. This

may not be a fair comparison as the students in the 1992 study were from all forms and this study

only included Belize City third formers. Indeed this study’s prevalence rate is closer to that

found by Briceño-Perriott (20ll) for Belize university students (83.7%).

Further the small differences in prevalent rates for inhalants (7.6%), stimulants (1.9%),

tranquilizers (1.1%), crack (1.4%) and cocaine (2.4%) between once in a lifetime and current use

may indicate that a majority of those students who experimented with these illicit drugs continue

to use and may be abusers of the drug of choice.

4.1.2 Licit and Illicit Drug Use Pattern

Findings indicate that both male and female respondents use licit and illicit drugs at about

the same rate. However significant differences in sex were found in lifetime prevalence of four

50

drugs: tobacco (χ2 [1, 422] = 5.676, p = .07), marijuana (χ2 [1, 422] = 11.012, p = .001),

inhalants (χ2 [1, 422] = 3.795, p = .05), and crack (χ2 [1, 422] = 5.010, p = .025). These results

suggest that male respondents were more likely to have tried tobacco, marijuana and crack once

in a lifetime than female respondents. It was the female respondent, however, who was most

likely to have tried inhalants once. This use of inhalants has traditionally been observed among

street children in Mexico and Central American countries and its use is traditionally associated

with hunger suppression. Inhalant use has also been associated with efforts for weight loss by

girls given the drug’s hunger suppressive nature (Beuvais et al. 2002; Mosher et al., 2004).

Further research is necessary to determine whether these studies’ findings hold true for Belizean

adolescents.

The average age for illicit drug use was 13.6 years with no significant difference between

the sexes. The most frequent age for drug use initiation was 14 years, corresponding to early

puberty, a period during which many adolescents engage in risky behaviors, which include drug

and alcohol consumption. Additionally while seeking to establish identity adolescents seek to be

accepted by peers and may succumb to drug use due to peer pressure (Mishne, 1986; Zastro &

Kirst- Ashman, 2007). Indeed, respondents of this study reported that overall friends provided

them with both licit and illicit drugs providing support for Marcos, Bahr and Johnson (2001) who

posited that the best single predictor of drug use is association with drug-using friends. Further,

age of first drug use places the student/adolescent user in first and second year of high school

indicating that education and prevention programs need to start in the first year of high school as

students appear to be susceptible to drug use experimentation in the first and second years of

high school.

The pattern of drug use shows that males first consume licit and illicit drugs earlier than

their female counterparts. Both alcohol and cigarette use was reportedly more frequently

consumed at home, at a friend’s house or at a social event which may explain the high

percentage of binge drinking—consuming 5 or more drinks in one sitting. Although no

significant differences were determined between female and male binge drinking, males

admitting to binge drinking more frequently than females in the two weeks prior to participating

in the survey. Males further admitted to getting drunk more frequently than females.

Furthermore, respondents obtained both tobacco (cigarettes) and alcohol mainly from friends and

51

neighborhood grocery shops. Purchasing of cigarettes and/or alcohol is illegal and shows non-

compliance of Belizean laws and possibly non-monitoring by relevant authorities. Non-

compliance with Belizean law may be reflective of an existing cultural norm where cigarette and

alcohol use are seen as not harmful, openly used in family events where children are present and

where minors are sent to purchase the licit drugs. When students were asked whether cigarette

use and alcohol use were harmful about 15% believed use of these drugs were either not harmful

or had no knowledge whether use was harmful. Education programs are imperative for this group

of students.

While the vast majority reported never having been offered to consume or to buy illicit

drugs, marijuana was reportedly the most pushed drug among students either to consume or to

buy making marijuana the illicit drug of choice for third year high school students. This finding

is similar to that found by NDACC (2002). Venue for marijuana consumption was highest at a

friend’s house followed by the home. The main providers were friends followed by the street

pushers.

Cocaine and crack are reportedly the least used drugs; however there appears to be a clear

preference by sex among current users. Current cocaine use is more prevalent among girls while

current crack use is more prevalent among boys. The venue for cocaine use is at a friend’s house

and friends reportedly are the main providers. A higher percentage of females reported using the

illicit drug at home. A possible explanation for crack and cocaine use in a house may be the users

feel safer using in the house as they may be afraid of getting into trouble with the law.

There is parity among the sexes for stimulant users both in the past year and currently

with approximately 1 in 3 users obtaining their drug of choice at pharmacies. It is of grave

concern that a third of current users obtain the drugs from pharmacies as the laws of Belize

require that these drugs be sold only with prescriptions. A clear female sex preference is

noticeable among tranquilizer users both in the past year and currently of which approximately

20% currently obtain their drug of choice from the home and 10% from friends. Similarly, MTF

(2011) found that 20% of Twelfth Graders (Form 4) in the United States reported that they

obtained prescription medication for non medical use from friends or relatives. Providers for

Belize prescription medication for non medical use appear to be similar to that for high school

students in the United States: friends and relatives. Respondents were not asked whether the

52

prescription medication for non-medical use was provided willingly by the relatives in the home;

therefore, the drugs could have been obtained without consent or knowledge of the relative.

4.1.3 Perception of Illicit Drug Access & Curiosity about Illicit Drugs

Marijuana is perceived to be the easiest illicit drug to access, which may correlate with it

being the most used illicit drug. Of the respondents that perceived marijuana to be difficult to

obtain and do not know how to obtain it, a small proportion had consumed marijuana which may

suggest experimentation with the drug in the company of friends—friend’s house is reportedly

the preferred venue for smoking marijuana. The latter may be further supported given that a little

over half (50.8%) reported being offered to consume while 37.6% were offered to purchase

marijuana. The percentages to consume or to buy all other illicit drugs were in the low single

digits and may suggest the absence of an aggressive retail drug market for these drugs or perhaps

that deterrent strategies to combat drug use are having some impact.

Being curious may be second nature to being an adolescent. A good majority

(61.2%) was not curious to try an illicit drug and a larger majority (66.9%) would not try an

illicit drug. While this may reflect some of the positive effects of the national drug prevention

strategies, it also raises concerns on the need to intensify efforts to reach the combined 38.8%

who were indecisive, not curious and curious about trying an illicit drug. Similarly, a combined

33.1% were not sure whether they would try or would be willing to try an illicit drug. The

apparent openness towards drugs by about a third of the respondents may imply the need for a

more aggressive and strategic prevention approach. Verily, a percentage of students who

declared they would not try or were not sure they would try an illicit drug have indeed consumed

an illicit drug indicating that students are saying one thing and doing another.

4.1.4 Perception of Licit and Illicit Drug Use Health Risk

While most students believed that drug usage is harmful, there were noticeable variations

in perception about specific drugs. Frequency of drug use had an impact on the perception of

health risk as the percentage of those who believed drug use was harmful increased as the

frequency of usage increased from sometimes to frequently. Additionally, perception of health

53

risk also increased with type of drug, with ―hard drugs’ such as cocaine and crack believed to be

more harmful. However, 27.2% of students (the largest proportion in this category) perceived

marijuana use as not harmful. This may suggest that perception influences drug consumption

preference considering that marijuana was the most used illicit drug and perceived lowest than

all other drugs in the very harmful category. Further research is needed to verify this assumption.

Careful consideration should be given to Belize’s direction in decriminalizing marijuana and the

possible impact this may have on adolescents. The variations in perception may also be

signaling a need for drug education among adolescents.

4.1.5 At-Risk Factors for Licit and Illicit Drug Use

Standard multiple regressions were conducted on socio-demographic variables, main

residence, ethnicity, sex and family of origin, to determine at-risk factors for ever using tobacco,

alcohol, marijuana, prescription medication (stimulants and tranquilizers) for non-medical use,

inhalants, cocaine and crack in this population. Results indicated that being male is an at-risk

factor for using tobacco, marijuana and crack and being female an at-risk factor for using

inhalants. Further, main residence as reported by the study’s participants was also determined as

an at-risk factor for using inhalants. Therefore, being female and living in Southside Belize place

students in this sample at risk for inhalant use. Likewise, living in Belize City places the female

student more at risk for ever using inhalants than the female student living in rural Belize.

Family of origin was also determined as an at-risk factor for crack use. Being male and living in

an extended or blended family increases the risk of the third year student for crack use.

A possible explanation for this at-risk factor may be that the extended family may be

large and so children are left to their own devices or the integration of blended families may not

leave time for individual attention to each child, especially the adolescent who is not a child but

not yet and adult. Indeed this specific result lends credibility to Musse’s (1988) theory that lack

of a positive relation with parents is one of the strongest predictors of problem behaviors among

youths including drug use and abuse among adolescents. Ethnicity was not determined to be a

risk factor for students in the study which may suggest that all ethnic groups are equally

vulnerable or resilient to drug use. These findings highlight vulnerabilities that should be

considered in any strategic response in drug prevention and reduction.

54

Conclusion

The present analyses indicate that alcohol and marijuana are the main drugs used by

Belize City third year students and prevalence for both is high. Tobacco (cigarette) is also used

but to a lesser extent than alcohol and marijuana. Prevalence for other illicit drugs is much lower

than that for alcohol, tobacco and marijuana. Interestingly, there were no sex differences in

frequency of drug use except for four drugs -tobacco, marijuana, inhalants and crack. In both licit

and illicit drug categories reported prevalence decreased from lifetime to past year to current use

suggesting experimentation with these substances by a large percentage of third year students.

Indeed there is approximately a 20% difference in prevalence rate between lifetime and current

use in tobacco, alcohol and marijuana indicating major experimentation with these three drugs.

The difference in prevalence for other illicit drugs was very small conveying that once students

used these drugs, they continued to do so.

Interestingly, inhalants are the only drug that is the drug of choice for females. Verily,

16% of the population reported having tried the substance and of these 10% were female. Chi

square tests indicate a statistical difference in regard to females. Alcohol appears to be the first

drug choice of this population and presents an interesting pattern. Half of the third year students

whether male or female who drink alcohol binge drink. Although no significant sex differences

emerged in alcohol use, males binge drank more than females in the two weeks previous to

participating in the study. Moreover, the number of students who binge drank decreased as

number of times of binge drinking increased. Mixed drinks and rum are the main alcoholic

beverages of choice as reported by the third year students with beer the main choice of males.

Age of first drug use was early (approximately 13.6 years). Students access licit and illicit

drugs from friends and use these drugs mainly in the home, friends’ homes and social events.

Alcohol and cigarettes are also purchased from grocery stores suggesting that monitoring of

these stores is necessary. An important finding is that third year high school students’ access

prescription drugs for non-medical use from pharmacies signifying a need for more stringent

monitoring of these establishments.

A very important finding relates to third year high school students’ perception of how

easy it is to access illicit drugs. Perception of availability of marijuana was very high with half of

55

the third year students admitting to being offered marijuana to consume and 1 in 3 students were

asked to purchase marijuana. A noteworthy finding is that only a negligible number of third year

high school students reported being offered crack and cocaine.

It should be noted that a relatively high proportion (about 20%) of the third year high

school students do not know of the dangers of taking tranquilizers sometimes or frequently;

inhaling solvents sometimes or frequently; and consuming ecstasy sometimes or frequently.

Additionally from 8 to 13% did not know the dangers of any of the other drugs. Further 3 to 10%

believed that any drug use is not harmful. Also a large proportion of third years students believe

that marijuana used sometimes or frequently is not harmful. This has great implications for

prevention education.

Analyses of the data determined that being male is an at-risk factor for ever using

tobacco, marijuana and crack. Living in an extended or blended family increased the risk for

crack use. Being female and living in south side Belize City increased the risk for using inhalants

among third year high school students. While many in Belize may be of the opinion that

adolescents especially those in school ought not to do drugs or are not doing drugs, results of this

study indicate that they are indeed doing both licit and illicit drugs which demands intensified

efforts for prevention and drug demand reduction.

Indeed, the results of this current study highlight some alarming trends in alcohol and

drug use within this sample of Belize City third year high school students. Findings further show

that a large proportion of these students drink to excess particularly in the form of binge drinking

which is of great concern considering the risks of binge drinking. With over half of the sample

reporting some kind of drug use, it is evident that drug use, specifically alcohol use, is part of the

student culture. This reality has also been found globally and regionally and may pose significant

social implications that demand a collective and urgent response. It is noteworthy to highlight

that adolescent males are at greater risk than female adolescents for drug use and any strategic

response must take this finding into consideration.

56

Recommendations

Drug use prevalence patterns are constantly changing, therefore timely information is

necessary for policy makers and for prevention and drug demand reduction efforts. The findings

of this study provide:

Current information on adolescent licit and illicit drug use and pattern

Relevant stakeholders including school authorities and drug prevention specialists

with local information for strategic action

Information for evidence based policy development

Specific Recommendations

4.3.1 Research

Conduct research studies to:

Establish if perception of harm influences drug use

Identify the specific tranquilizers and stimulants being purchased at pharmacies by

minors

Determine reasons for female inhalant use preference

Replicate the current study nationally

Conduct a comparative study on drug prevalence and pattern with out-of-school

adolescents.

4.3.2 Prevention and Intervention

Given that a proportion of students are not aware of the health risks that licit and illicit

drugs pose, drug education should be incorporated in the formal school curriculum within

the first two years of high school.

57

Relevant authorities need to enforce laws that regulate the selling of alcohol and tobacco

(cigarettes) to minors.

Likewise relevant authorities need to enforce laws that regulate the selling of controlled

drugs without prescriptions.

Relevant stakeholders including NDACC and school authorities need to develop tailored

responses for adolescents at-risk for drug use.

The relevant authorities should invest more resources in preventative strategies

addressing health risks associated with adolescent drug and alcohol use, specifically

binge drinking.

There is also a need to provide adolescent intervention programs that include early

detection and primary care for adolescent users.

58

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Briceño-Perriott, J. E. (2011). Alcohol and drug use among University of Belize FMSS students,

Belize City Campus. Belize City: University of Belize.

Cayetano, E. C. (2006). Belize Study: Gender alcohol and culture GENACIS 2005 final report.

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CICAD. (2003). Drug prevalence survey of secondary school students: A comparison report for

selected countries in the English Speaking Caribbean. Washington, D.C.: OAS. Retrieved

from http://www.cicad.oas.org/oid/Estadisticas/siduc/3caribe-siduc/3caribbean_siduc.pdf

Emmanuel, E. (2008). Belize (Ages 13-15) Global Youth Tobacco Survey. Washington: PAHO.

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adolescent drug use. Social Forces (65)1, 135-161.

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A comprehensive response (3rd

ed.). Belmont, CA: Brooks/Cole.

Méndez Ramírez I., Namihira Guerrero D., Moreno Altamirano L., & Sosa de Martínez C.

(1997). Research protocol. Mexico City: Editorial Trillas.

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APPENDIX 1

62

APPENDIX 2

Informed Consent Form

(Parents)

I, ________________________________________________, accept that my child

(Parent’s Name)

who attends ______________________________ School, participates in the project entitled

(Name of School)

―Prevalence and Pattern of Drug Use in Belize City Third Year High School Students‖ that is

being conducted by the University of Belize in collaboration with the National Drug Abuse

Control Council.

I declare that I understand and am in agreement with the following:

1. This project is fundamental in understanding the manner in which drug use is affecting

adolescents and in proposing programs and policies so that governmental and non-

governmental organizations/institutions that deal with these issues better their prevention,

intervention and treatment practices.

2. The information that my child divulges shall be held in the strictest confidence and shall

only be used for the purposes of this study.

3. To be able to participate in this study, my child shall (a) return this letter of informed

consent signed by me to the investigator and (b) complete a questionnaire given at his/her

school.

4. There is no cost to me or my child for participating in the survey.

5. My child nor I will receive any direct benefits but the results will help others in the future

as they will be used by the National Drug Abuse Council to help implement relevant

strategies for drug use reduction.

6. My child may feel some discomfort in answering certain questions as drug use is a

sensitive issue to many adolescents. In the event my child feels emotionally upset as a

direct result of this research study, referral for counseling services at no cost to me shall

be provided. In this event, my child or I should contact Dr. J. Perriott at 667-4583.

7. The results of the study will be analyzed, discussed and published in local, international

scientific journals and/or specialized texts always maintaining confidentiality and

keeping my child’s identity anonymous.

____________________ ____________________

Parent’s Name Signature

63

APPENDIX 3

Letter of Informed Consent (Student)

August 18, 2012

Dear Student:

You are being invited to participate in a research study conducted by the University of Belize

(UB) and the National Drug Abuse Control Council (NDACC). The researchers include UB

professors as well as NDACC and Ministry of Health personnel. Very little research has been

conducted on student issues in our country. This questionnaire has to do with alcohol and drug

use. Some of the questions are very personal. Because they are personal, there has been a

reluctance to investigate them. However, if government organizations such as NDACC are to

provide excellent prevention and harm reduction programs, we need to know your views in

regard to alcohol and drug use even if we have to ask personal questions.

The objective of this research study is to determine the pattern of alcohol and drug use among

students in Belize City in order to obtain empirical data to formulate strategies for the

development of policy and services for the prevention and reduction of alcohol and drug use

among adolescents. Your participation will consist of filling out the attached questionnaire

which will take about 25 minutes. It is being given to all third year high school students in Belize

City. Your participation in this research study is voluntary and you can only participate if your

parents have signed the letter of informed consent. If you decide to fill out the questionnaire,

you may refuse to answer certain questions or stop answering the questions at any point that you

feel uncomfortable. Should you feel emotionally upset and need to speak to someone,

counseling services shall be provided free of cost to you. Should you require these services, call

Dr. Jean Perriott at 667-4583.

Please note that this survey is anonymous therefore, the necessary steps have been taken to

safeguard your privacy. You do not need to put your name on the questionnaire. When you have

completed the questionnaire, put it in the envelope that will be given to you, seal it and return it

to the data collector. The data collected will only be seen by the researchers. The questionnaire

will be destroyed after the project is completed and should the data collected be published, your

identity will not be revealed.

By returning the completed questionnaire, you are indicating your willingness to participate

freely in this research study. You are further indicating that all your present questions have been

answered in language you understand and that you understand that all future questions will be

answered in a similar manner.

Thank you for considering this invitation to participate in this study.

Sincerely,

__________________________

Dr. Jean Briceño-Perriott

Principal Investigator

E-Mail Addresses: Dr. J. Briceñ[email protected] Fermin Olivera [email protected]

This publication or any part thereof may be freely reproduced. Prior permission is not required but credits would be much appreciated. A copy of any publication in any form in which the content or part thereof is reproduced would be greatly appreciated.

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Prevalence and Pattern of Drug Use in Third Year Belize ... Use in Belize City.pdf · Prevalence and Pattern of Drug Use in Third Year Belize City High School ... Significant Differences