1. The 2000 Survey of Drug Use Among Students The Action Committee Against Narcotics (ACAN) by Dr. Joseph T F LauDirector Mr. Mason LauProject Co-ordinator Dr. KS ChongResearch Associate Ms. H Y TsuiProject Co-ordinator Dr. K S LeungResearch Associate Dr. W S WongResearch Associate Centre for Clinical Trials and Epidemiological Research, CUHK Dr. Y W ChoiGeneral Secretary, Breakthrough Limited Dr. C M YuConsultant, Department of Paedatrics Pamela Youde Nethersole Eastern Hospital Prof. C K WongChairperson, Positive Living United Services

2. Table of content  Background  I. Admitting & Monitoring the problem  II. Age and Drug use - early prevention  III. Settings of drug use - curiosity, friends, money, & sex  IV. Perceptions & Attitudes  V. Social context - conducive to drug use ?  VI. Type of substance use  VII. Gateway substances  VIII. Adequate Quitting Programs ?  IX. A potential screening instrument  X. Recommendations

3. Background  95,788 students surveyed Respond rate 72% Chinese speaking secondary schools87.3% 8% International schools91.2% 20% IVE67.3%  Fieldwork: October 20, 2000 to March 8, 2001  Anonymous, structured questionnaire (comparable to previous studies)  Two-stage stratified cluster sampling method(by ACAN)

4. Objectives 1) To obtain information about the drug use pattern of students in Hong Kong 2) To access these students’ knowledge and attitudes towards drug use 3) To find out students’ exposure to the risk of drug use 4) To study the reason why students use drugs 5) To identify drug use related factors: demographic, family, attitudinal, behavioral and school

5. I. Admitting & Monitoring the problem

6. Prevalence: Ever users Alcohol (%) Tobacco (%) Psy. Sub. (%) Heroin (%)

7. Prevalence: Current users Alcohol (%) Tobacco (%) Psy. Sub. (%) Heroin (%)

8. Prevalence current / ever users Current users (%) Ever users (%) ‘92‘96‘00 ‘92‘96‘00 Alcohol14.525.830.2 73.971.079.7 Tobacco9.010.19.7 26.823.722.2 Heroin0.10.80.9 0.42.12.6 Psychoactive substances0.80.62.1 3.12.74.1

9.  35 % at least once per week  57% at least once per two weeks Frequency (current psychoactive substance use)

10. Prevalence: Heroin ever-users Ordinary Day School (%) International School (%) IVE (Full Time) (%)IVE (Part Time) (%)

11. Prevalence: Psychoactive substances ever-users Ordinary Day School (%) International School (%) IVE (Full Time) (%)IVE (Part Time) (%)

12. Ordinary Day School (%) International School (%) IVE (Full Time) (%)IVE (Part Time) (%) Prevalence: Psychoactive substances current-users

13. School type Chinese school International School IVE (part time)IVE (full time) Substance abuse not harmful to health 15.1%22.3%27.6%15.5% Heroin not harmful to health 12.4%8.7%26.1%13.1% K is not harmful17.9%14.3%30.8%18.2% Drug does not destroy your life 14.8%13.6%29.6%13.4% Heroin not addictive15.3%31.5%20.9%13.5% K not addictive18.9%35.7%28.0%17.5% Psychoactive substance not addictive 20.1%38.0%27.2%18.9%

14. School type Chinese school International School IVE (part time)IVE (full time) Knowing psychoactive substance users < 20%22.9%37.5%< 20% Offered psychoactive substance 5.1%12.8%21.2%6.3% Felt easy to obtain heroin10.1%13.9%20.0%11.7% Felt easy to obtain psychoactive substance 13.4%19.2%24.8%15.4% Would take psychoactive substance in the future 12.5%16.6%25.9%12.4%

15. School type ~ Prevalence (Ever-users) Chinese school International School IVE (part time) IVE (full time) Alcohol78.6%94.9%90.7%90.5% Tobacco21.0%31.4%54.8%29.0% Heroin2.5%3.1%8.0%3.0% Psychoactive substances 3.7%10.7%15.2%4.1%

16. School type ~ Prevalence (Current users) Chinese school International School IVE (part time) IVE (full time) Alcohol28.7%44.3%57.0%43.8% Tobacco8.9%13.5%37.2%13.2% Heroin0.8%0.9%3.1%1.0% Psychoactive substances 1.9%4.5%10.1%2.0% ** Significant after adjusting for age (Table 4.8.2, 4.8.1) * Age distribution (Table 1.1.3) *** Change of prevalence of heroin use was stable for all school types except among IVE part-time students (0.6% in 92, 1.9% in 96 and 3.1% in 00)

17. II. Age and Drug use - early prevention

18. Prevalence of “ substance users ” by age Age ≦ 12 131415161718 ≧ 19 Alcohol18.9125.3628.7431.1134.3533.9937.4844.48 Tobacco3.376.289.6111.9513.0511.2610.1115.47 Heroin0.480.721.170.990.740.530.661.60 Psychoactive substances 0.881.442.122.542.662.551.783.24 Current users Age ≦ 12 131415161718 ≧ 19 Alcohol65.1372.6477.5181.7385.4487.4988.9991.12 Tobacco9.3615.5221.9225.2128.2926.4426.9134.39 Heroin1.842.252.962.762.512.182.374.24 Psychoactive substances 1.892.803.904.485.335.074.265.97 Ever users

19. Characteristics of ever-users SubstancesAge of First Use Alcohol 61% ≦ 12 Tobacco 49% ≦ 12 Heroin 56% ≦ 12 Psychoactive subs. 50% ~ 13-16

20. Age of first use of different drugs (ever users) : ≦ 12 Ordinary Day SchoolInternational SchoolIVE (Full time)IVE (Part time) 199219962000199219962000199219962000199219962000 %%%%%% Alcohol 72.972.062.677.267.164.844.139.235.338.840.637.7 Tobacco 67.759.251.458.148.342.941.439.027.941.741.033.7 Heroin 27.247.758.013.225.043.928.541.747.217.030.445.2 Psychotropic substances 33.031.032.718.811.625.29.216.221.912.812.525.0

21. Age of first used (years old) Characteristics of Ever-users

22. Prevalence of using psychotropic substance use for different age groups MalesFemales % All F3 students * 1-month3.32.0 Lifetime5.43.7 Age 15-18 * Ordinary School 1-month2.61.8 Lifetime4.93.7 IVE-Full time 1-month3.71.1 Lifetime7.03.0 IVE-Part time 1-month13.59.9 Lifetime19.012.8 Age 18-24 @ All9.35.5 * ACAN 2000 study @ another study

23. Taking drugs at least once a month in last 12-month Employment status Full time5.5 Part time8.0 Students0.7 Unemployed11.4 Among aged 18-24 (Males) Prevalence of using psychotropic substance by employment status

24. Many users start using drugs between age 15 – 18, especially among school leavers

25. III. Settings of drug use - curiosity, friends, money, & sex

26. Reasons for first drug use Characteristics of Ever-users

27. Places taking drugs – Ever-users Characteristics of Ever-users

28. With whom ? (Ever-users) Characteristics of Ever-users

29. Source of drug for Ever-users (if desired) Characteristics of Ever-users

30. 29.8% of all ever-users of psychoactive substances had had sexual intercourse after drug use  male 37.2%  female 19.5% Sex and Drug

31. Source of Money Characteristics of Ever-users

32. IV. Perceptions & Attitudes

33. Perception / Attitudes % Perceived not harmful HeroinPsy. Sub.Ecstasy / K Male Female

34. Perception / Attitudes % Perceived not addictive HeroinPsy. sub.Ecstasy / K Male Female Taking Psy.sub. as hobby

35. Perception / Attitudes HeroinPsy. sub. Male Female % Approval of use (Occasional use)

36.  Inclination for future drug use: 12.9% Male 13.7% Female 12.0% (Likely / very likely to use psy. sub. is significant to predict abuse) Perception / Attitudes

37. % Perceived not harmful HeroinPsy. Sub.Ecstasy / K Students Ever Using Heroin or Psychoactive Substances Students Never Using Heroin or Psychoactive Substances

38. Perception / Attitudes % Perceived not addictive HeroinPsy. sub.Ecstasy / K Taking Psy.sub. as hobby Students Ever Using Heroin or Psychoactive Substances Students Never Using Heroin or Psychoactive Substances

39. Perception / Attitudes HeroinPsy. sub. % Approval of use (Occasional use) Students Ever Using Heroin or Psychoactive Substances Students Never Using Heroin or Psychoactive Substances

40. V. Social context - conducive to drug use ?

41. Social context - Family  5% had one or both parents passed away 12.4% not living with both parents  Communication and appreciation are lacking About 50%-60% found their situation: similar to – ‘parents do not understand their children’ dissimilar to – ‘parents want to hear their children’s problem’, ‘parents like they way their children are’  3% reported beaten to injury by their parents in the past six months

42. Social context - Schooling  Perceived too much pressure from school work (50%)  Being blamed by teachers and parents due to undesirable academic performance (19%)  Being bullied by classmates / schoolmates (Female 13%, Male 22%)

43. Exposure to risk (1)  Involved with triad society - Male 10%, Female 6%  Acquaintance with drug users: 15%  Not mind getting along with drug users: 29%

44. Exposure to risk (2)  Easy to obtain drugs Heroin11% Pyshoactive substances14%  Ever being offered psychoactive substances 6% at disco / rave parties39.4% in China3.3% offered from friends55.3% offered from classmates20.7%

45. Social connectiveness School Family ? (Exposure to risk) The mentioned characteristics were highly significant in predicting substance use

46. VI. Type of substance use

47. Patterns for current use of psychoactive substances  MDMA and Ketamine most commonly used, except that cannabis was the most common psychoactive substance used by current users in international schools  Number of using cannabis and cough medicine declines  Female was more likely to use MDMA than male  Students under age 12 were less likely to use MDMA but more likely to use cough medicine, solvents etc.

48. Most commonly Ever & Current used drugs % %

49. Most commonly ever and current used drugs Ever UsersCurrent Users MDMA41.8%MDMA38.2% Cannabis38.0%Ketamine34.5% Ketamine33.3%Cannabis26.9% Cough medicine 23.7% Cough medicine17.5% Solvents21.1%Solvents16.5% Methylamphetamine 14.1% Methylamphetamine 12.2% Methaqualone11.2%Flunitrazepam11.9% Flunitrazepam10.8%Methaqualone11.3%

50. Most commonly current used drugs Ordinary Day SchoolInternational SchoolIVE (Full time)IVE (Part time) 199219962000199219962000199219962000199219962000 %%%%%% Cannabis30.254.325.367.188.255.437.877.622.355.570.025.4 Cough medicines 52.937.516.114.57.716.555.628.610.533.627.012.1 Solvents12.423.016.39.810.012.56.718.45.84.110.06.8 Flunitrazepam13.314.49.41.70.54.48.914.33.410.310.07.9 Cocaine0.18.66.511.65.97.62.214.33.13.47.03.4 Methylamphetamine NA15.412.2NA5.99.5NA12.27.7NA10.07.9 MDMANA9.442.2NA5.017.5NA6.136.1NA9.035.9 Methaqualone5.98.89.5NA 4.9NA8.24.93.42.07.6 KetamineNA 37.2NA 17.1NA 30.8NA 34.8

51. VII. Gateway substances

52.  Ever drug users Association between ever using different types of substances HeroinPsychoactive substances Alcohol or tobacco ever-users OR = 4.39*** (adjusted for age and gender) OR = 6.34*** (adjusted for age and gender) The ever-users of psychoactive substances were also very strongly associated with the ever use of heroin (OR = 13.96, p < 0.001)

53.  Current drug users Association between currently using different types of substances HeroinPsychoactive substances Alcohol or tobacco current users OR = 20.2*** (adjusted for age and gender) OR = 15.8*** (adjusted for age and gender) The current users of psychoactive substances were also much likely to be current heroin users (OR = 48.7, p < 0.001)

54.  Ever drug users Association between ever using different types of substances HeroinPsychoactive substances Alcohol ever-users OR = 3.48 (adjusted for age and gender) OR = 5.02 (adjusted for age and gender)

55.  Ever drug users Association between ever using different types of substances HeroinPsychoactive substances Tobacco ever-users OR = 9.48 (adjusted for age and gender) OR = 15.02 (adjusted for age and gender)

56.  Current drug users Association between ever using different types of substances HeroinPsychoactive substances Alcohol ever-users OR = 6.47 (adjusted for age and gender) OR = 7.74 (adjusted for age and gender)

57.  Current drug users Association between ever using different types of substances HeroinPsychoactive substances Tobacco ever-users OR = 27.83 (adjusted for age and gender) OR = 22.55 (adjusted for age and gender)

58. VIII. Adequate Quitting Programs ?

59. Attempts quitting drugs Ever users Current users Never attempted to quit43.9%48.4% Attempted but failed23.9%32.5%

60. Likely to attempt quittingLess likely to attempt quitting  male  perceived not harmful  age >15  perceived not addictive  borrowed money for drugs  easy to obtain  age of initiation < 16  MDMA, Cannabis users Factors determining whether attempted quitting among Current users

61. ReasonEver usersCurrent users Never attempted to quit Not addictive48.8%43.1% Not dangerous24.0%25.5% Uncomfortable8.9%11.8% Attempted but failed Peer pressure6.8%9.9% craving7.4%9.6% Reasons

62. IX. A potential screening instrument

63. DRUG USE Perception/ Attitude Low perceived addictiveness Low perceived harmfulness Approval of use Social Context (Connectiveness) Alcohol & Tobacco Use (Current drug users) Alcohol- 30% Tobacco-10% Other Factors Physical abuse - Current OR=1.8 (for heroin), OR=1.4 (for psy.sub.) Behavioural problems, Peer influences Demographic Factors Age (older student) Temporary housing (OR=2.35) School type A Predictive model of Drug use among Adolescent About 25 variables, high sensitivity and specificity (over 90%)

64. Early screening prevention  Labeling effects?  How to implement?

65. X. Recommendations

66. Recommendations Building connectiveness Clarifying concepts (addictiveness, harmfulness etc) Assessing impact of alcohol and tobacco use on substance abuses Early preventive intervention, programs to school leavers ■ ■ ■ ■

67. Monitoring changing patterns of substance used, surveillance on trends Relationships with other behavioral problems, crimes and sex, joint effort desired Quitting programmes for youths Recommendations ■ ■ ■

68. Peer education Control of rave party and drug-use in mainland China Dissemination of results A predictive model and screening instrument Recommendations ■ ■ ■ ■