الفهرس 
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Abstract
Substance use is a serious and growing health problem all over the world. It has great social-economic impacts that touch the future of the young generation and influence the infrastructure of such dynamic states. It is considered one of the most significant threats to adolescents who abuse it and their families. Indeed, substance use affects all sectors of society in all countries; in particular, it affects the freedom and development of young people, the world’s most valuable asset.
Adolescence is a time when enormous changes take place in the process of normal development. It is ”a time for developing a person’s sense of self-identity, a process that involves separating from parental attachments and values and establishing new social ties, values and ideals.
Globally, the alarming increases in illicit drugs problems both reflect and contribute to international tensions as: rapid changes in political alignment, reduced family and community cohesiveness, increased unemployment and underemployment, economic, social marginalization and increased crime. The World Drug Report 2018 declared that, over five percent of the adult population, or nearly 275 million people between the ages of 15 and 64 used at least one drug and there are over 29 million people classified as suffering from drug user disorders.
In Egypt, substance use has been emerging as a serious public health issue. Recent studies demonstrated that prevalence of substance use among Egyptians double of the world prevalence rate, that equal to 12.6%. It is also evident that an increases in the use of tobacco, illegal drugs and over-the-counter drugs, particularly among youth.
In this respect, The World Health Organization (WHO, 2017) Department of Mental Health and Substance Use organized for the first time the global Forum on Alcohol, Drugs and Addictive Behaviors (FADAB) with primary goal to enhance public health actions in these areas by strengthening partnerships and collaboration among public health oriented organizations, networks and instructions in the era of Sustainable Development Goals 2030 (SDG 2030)
Hence, the present study aimed at identifying the effect of implementing preventive interventions on substance use among male preparatory school students in Alexandria.
True experimental research design was adopted to carry out this study. It had been carried out at four governmental male preparatory schools representing two out of the eight educational zones in Alexandria governorate namely (El-Montazah and East educational zones) that target urban, suburban and rural communities.
The present study sample included a total of 3493 male preparatory students by using multi-stage sampling technique; Alexandria Governorate is divided into eight educational zones affiliated to the Ministry of Education. Two out of the eight zones (El-Montazah and East) were selected as they have the largest number of male preparatory schools.
Two governmental male preparatory schools were randomly selected from El-Montazah educational zone namely: Elbactoshy and El-Shaheed Hanafy Mahmoud and from East educational zone namely: Esmael Elkabany and Mohamed Hafez. All students in the first and second grades in the previously selected schools were screened by using Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).
By using proportional allocation method thirty students was randomly selected from the 1st and 2nd grades from those having mild or moderate substance use related risk in each school (total number was 120 students). Two schools (one from each zone) were blindly assigned to select the study group (60 students) and the other two was for the controls (60 students).
Tool of study
Two tools were used in this study. Tool One: students’ socio-demographic and health profile structured interview schedule. It composes four parts: 1st part: personal and socio-demographic data about the students. 2nd part: students’ life style. 3rd part: students’ Health Profile.4th part: students’ social and educational profile. The tool was tested for validity and reliability.
Tool Two: The Arabic version of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). It was developed by the World Health Organization (WHO) by an international group of researchers and clinicians. It was designed as a technical tool to assist with early identification of substance use related risk and disorders. It composed of eight main questions asking about risky use of a) tobacco, b) alcohol, c) cannabis, d) cocaine, e) amphetamine-type stimulants, f) sedatives, g) hallucinogens, h) inhalants, i) opioids and j) other drugs.
Approvals were obtained for conducting the study at the specified settings. A pilot study was carried on 30 students to assure the clarity, applicability and comprehensiveness of the tools. The study was conducted in in a period of 15 months; the first 3 months were for screening of students (from October to December 2016) and the next 6 months for implementation of the preventive measures session (from February to July 2017). Data was collected by the researcher then appropriate descriptive and analytical statistics were carried out.
The main findings obtained from the study were as follow:
Part I: - Personal and biosocio-demographic characteristics of the students and their families:
• Students’ age ranges from 12-18 years with a mean of 13.54 ±0.825 years.
• More than half of the students (59.3%) were enrolled in the first preparatory grade, while the rest (40.7%) were enrolled in the second grade
• Students’ birth order ranges from first to fourth and more. More than one third (35.3%) of the students ranked the first child, while nearly one third (31.3%) of them were the second child.
• Slightly more than two fifth (41.3%) of the students were living in urban areas, while one third (35.1%) of them were living in sub-urban areas, and the rest (23.6%) were living in rural areas.
• The number of family members ranges from two to six and more with a mean of 3.26 ± 1.055.
• The majority (88.5%) of the students were living with both parents while, less than one tenth (9.6%) of them were living with their mother only.
• Students’ fathers’ age ranges from 30 to 70 with a mean of 48.87 ±13.31 years, while their mothers’ age ranges from 25 to 65 years with a mean of 39.13 ±7.54 years.
• Nearly one third (32.9%) of the students’ fathers had secondary education, while more than one third (36.2%) of their mothers had secondary / technical education.
• More than half (50.9%) of the students’ fathers were skilled workers, while the majority (85.4%) of mothers were housewives.
• More than two thirds (77%) of students don’t know their families income and one tenth (10.9%) of them had monthly income 1000 L.E and more.
• Less than one third (32.9%) of the students had insufficient monthly income and more than quarter (29.9%) of them had enough monthly income.
• More than half (59.7%) of the students reported that they were living in separate houses either owned or rent.
• Nearly two thirds (65.1%) of the families had a crowding index of 3to less than 5 persons / room.
• Approximately half (50.4%) of the students were belonging to the low middle social level and slightly more than two fifths (44.3%) of them were of low social level.
- Students’ life style:
• Less than three quarters (71.6%) of students obtained three meals or more per day and more than half (57%) of them reported that they sometimes receive these meals outside their homes.
• One third (35.8%) of the students sometimes drink tea, only 1.5% of the them always consumed coffee, slightly more than one quarter (26.2%) of them sometimes drink Nescafe and those who sometimes and always consumed cola constituted (25.9% and 15.4% respectively).
• Half (50.2%) of students were reported that they not practicing any type of exercise.
• More than half (54.9%) of the students were sleeping 7 to 9 hrs per day with a mean of 8.23 ±1.473 hours.
•More than half (58.1%) of the students had sleeping problems, whereas, 60.2% of them had irregular sleeping and 30.5% had excessive sleeping.
- Students’ exposure to violence:
• The majority of students (85%) witnessing domestic violence between their parents.
• The majority of them (84.6%) were exposed to violence. The vast majority of them (98.2%) of them exposed to psychological violence and less than two thirds (62%) of them were exposed to physical violence.
• Two fifths (40.6%) of the students were mentioned that the main source of violence were their friends, followed by old sibling (39.3%) and teachers (28.3%).
• Less than three quarters (71.6%) of the students experienced violence for more than 10 times in the last year.
- Students’ life problems:
• All students (100%) had many problems, more than half (59.4%) of the students had educational problems, while psychological and emotional problems were experienced by 39.6% and 32.8% respectively.
• Slightly less than one third (31.4%) of them were preferred either to sit alone or to ventilate and talk to their friends.
• More than half (53.4%) of the students reported that they sometimes receive support during the problem from their mothers.
• Approximately one thirds (33.4%) of students reported that they were having health problems.
• Approximately one thirds (33.4%) of students reported that they were having health problems, slightly less than two fifths (39%) of them were having anemia and more than one quarter (27.7%) of them were having bronchial asthma.
• More than two thirds (69%) of the students were receiving treatment for their health problem.
• One fourth (23.4%) of the students were exposed to surgical operations.
• The vast majority (90.7%) of the students didn’t make any check up
- The students’ inter-familial, friends and teachers relationships:
• The highest percent (81.9%) of the students reported that their relation with their mothers is based mainly on mutual respect & love.
• More than two thirds (69.7%) of the students reported that their relation with their fathers are based mainly on mutual respect however, 32.2% of them their relation with fathers is a strict relation without debate.
• Nearly one third (33.4%) of the students their siblings deal with them in contention, quarrel and fight and also less than one fifth (17.2%) of them had control and domination relationships.
• One fifth 20.5% of the students had contention, quarrel relations and fight with their friends.
• More than one quarter (29.8%) of them deal with their teacher in a strict relationship.
Students’ scholastic achievement:
• The highest percent (82.8 %) of students were never failed at school.
• Slightly more than one third (36.1%) of the students had good scores and more than three quarters (77.4%) of the students referred their successful school performance to the hard studying.
• Slightly more than one quarter (25.2%) of the students weren’t attending to school regularly and slightly less than half (49.9%) of them were absent from school twice times/ week
• More than half (53.6%) of the students don’t’ like their schools.
- The students’ leisure time and participation in extracurricular activities:
• Nearly two thirds (63.6%) of the students were not participating in any extracurricular school activities and more than one third (36.3%) of them reported didn’t like to share in such activities was the main reason for not participating.
• Slightly more than two thirds (64.1%) of the students were spending their leisure time in practicing sports like playing football.
• Slightly more than two thirds (67.1%) of the students practicing their hobbies at the week end.
- Students’ work experience and financial resources:
• Slightly more than one fifth 20.9% of the students were working and more than half (59.4%) of them were involved in skilled work as (fishing, car workshops, dressmaker). While, 10.3% of them were toktok derivers.
• Slightly less than half (46.9%) of the working students spend 6 hrs/day in their work and more than one third (36.3%) of them spend 8hrs/day.
• Slightly more than half (50.8%) of them were working for self-financial support and less than half (47.5%) of them for supporting their families.
• Students’ personal monthly income ranged from 200 to 600 L.E. Slightly less than half (49.1%) of them had income from 200 to 400 L.E / month and more than two fifths (44.9%) of them had from 400 to 600 L.E / month.
• More than half (56.2%) of the students reported contradiction of work with school time schedule was the main reason for not continuing work.
Part II: Smoking and substance use among students, their families and friends:
- Tobacco/substances use among students’ families:
• More than three quarters (79.9%) of the students have one or more smoker family members. from those family members fathers constituted more than two thirds (67.4%) of the smokers followed by relatives (51.7%) then siblings (10.4% of them).
• The majority (85.6%) of them were smoking cigarettes while, less than one third (32.6%) of them were smoking shisha.
•Slightly less than one fifth (19.2 %) of the students have one or more substance users family member. The highest percent of those users were the relatives (61.5%) followed by fathers (32.7%).
• The highest percent (88.5%) of the students’ families were cannabis users, whereas less than one tenth (7.7%) of them were alcohol users.
- Tobacco/substances use among students’ friends:
• More than two fifths (44.5%) of the students have smoker friends. The number of those friends ranged from one to seven and more.
• The vast majority (92.2%) of those friends were smoking cigarettes while 42.1% of them were smoking shisha and saloom.
• Approximately one fifth (20.8%) of the students’ friends have one or more substance user friends and slightly less than half (48.1%) of them were abusing hashish.
• Just more than two fifths (43.2%) of them were abusing amphetamines and more than one third (36%) of them were abusing alcohol.
- Tobacco/substances use among students’ role models:
• More than one quarter (29.8%) of the students having smoker role model. from those role models teacher constituted (48.2%) of the smokers followed by friends (38.2%).
• Most (94%) of students’ role model were smoking cigarettes while, slightly more than one fifth (20.8%) of them were smoking shisha and saloom.
• Less than one tenth (8.8%) of students have one or more role model abusing substance. Three quarters (75.1%) of them were abusing cannabis, more than two fifths (44.7%) of them were abusing tramadol and approximate percent (43.4%) of them were inhalants users.
- Students’ tobacco/substances uses:
• Less than two fifths (37.4%) of the students were tried smoking or any type of substances.
• The age of starting smoking ranges from 8-14 and more years with a mean of 11.38 ± 2.849 years.
• Less than half (48.1%) of the students were staring cigarette smoking at the age of 10 to less than 12 years, whereas slightly less than two fifths (39.4%) of them were in the age of 12 to 14 years old.
• Curiosity and desire to experiment was the main reason cited behind students’ tobacco/substances (76.8%) use.
• Slightly more than one fifth (21.5%) of them were attributing their tobacco/substances use to the desire to escape from their problems and nearly one fifth (19.7%) of them were used tobacco/substances because of psychological pressure.
More than one third (37.4%) of the students were reported availability of substances in the surrounding environment. Additionally, the highest percent (79.2%) of the students reported that they weren’t facing difficulty to reach tobacco/substances.
• Less than three quarters (79.9%) of users were obtaining substance from distributors/sale men and 69.2% of them from their friends.
• Slightly less than two fifths (39.5%) of the students were forgetting what was happened to them, whereas nearly one third (32.8%) of them were experiencing fatigue as a result of their abusing of such substances.
• Guilt feeling about abusing substance were experienced by slightly more than half (51.7%) of the users.
• Slightly more than half (50.6%) of them were viewing it as high risk, compared to only 8.9% of them who rated it as no risk.
• Less than half (47.8%) of the students were thinking about quitting of tobacco/substances use however, slightly less than one third (31.4%) of them weren’t ready.
• More than half (59.6%) the students weren’t receiving any lessons about substance use and its hazards.
• The majority (85.6%) of the students mentioned that their friends were the first source of smoking followed by their families (21.5%).
- The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) version 3.0:
• The vast majority (93%) of students were tobacco smokers. Cannabis (hashish) was used by 55.5% of them followed by inhalants and other synthetic substance (23.3% and 22.8% respectively).
• The majority (83.5%) of students were abusing tobacco daily/almost daily compared to less than two fifths (38.3%) of them who were abusing alcohol weekly.
• Less than three quarters (71.6%) of cannabis users were abusing it weekly followed by 13.4% of them who were abusing it once/twice in their life time.
• All of the cocaine users were experienced it once/twice and more than two thirds (71.4%) of the amphetamines users were monthly abusing it. Less than half (45.6%) of the inhalants users were daily/almost daily using such substance.
• All of the sedative and hallucinogens users were daily/almost daily abusing while, half (50%) of the opioids users were daily/almost daily users.
• Slightly more than half (50.3%) of the students had a desire to use tobacco once/twice, compared to more than three quarters (76.1%) of alcoholic beverages users.
• Those who had the desire to use such substance once/ twice represented 85.7% of the amphetamine users followed by three quarters (75%) of the hallucinogens users, slightly less than three quarters (73.4%) of cannabis users, 62.5% of the opioids users, less than half (47.9%) of the inhalant users and just less than two fifths (38.9%) of other substance users.