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Published in: Substance Abuse Treatment, Prevention, and Policy 1/2018

Open Access 01-12-2018 | Research

Adolescents, parents and teachers’ perceptions of risk and protective factors of substance use in Moroccan adolescents: a qualitative study

Authors: Hicham El Kazdouh, Abdelghaffar El-Ammari, Siham Bouftini, Samira El Fakir, Youness El Achhab

Published in: Substance Abuse Treatment, Prevention, and Policy | Issue 1/2018

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Abstract

Background

Substance use in adolescents is a global public health concern that continues to draw attention from academics, policy experts, and government officials. In Morocco, few studies have investigated the influencing factors of substance use in adolescents. Here, we aimed to fill this gap and to better understand factors that protect or influence substance use in adolescents.

Methods

We conducted a qualitative study using focus group discussions. The semi-structured interview guides were based on the socio-ecological model as a theoretical framework to explore perceptions of students, parents, and teachers regarding substance use risks and protective factors in adolescents. Data from each group were audio-recorded, transcribed, and analyzed using thematic analysis.

Results

From May to July 2016, 17 focus group discussions were conducted at two middle schools in Taza city, Morocco, which included 8 groups of 7 adolescents (28 boys and 28 girls) aged 14 to 16 years, 5 groups of parents (5 females and 21 males), and 4 groups of teachers (13 males and 5 females). Thematic analysis resulted in six common themes that represented the most salient perceived risk and protective factors regarding substance use among adolescents: perceived benefits of substance use, awareness and beliefs, family influence, peer influence, easy accessibility of substances, and social norms.

Conclusions

Our results demonstrate that multilevel prevention programs in adolescents should address influencing factors from the individual to the societal level, including social norms and the government’s policy toward substance use. Health education programs included as part of the school curriculum can contribute to promoting awareness and reducing risky behaviors of Moroccan adolescents.
Literature
1.
go back to reference Gray KM, Squeglia LM. Research review: what have we learned about adolescent substance use? J Child Psychol Psychiatry. 2018;59:618–27.CrossRefPubMed Gray KM, Squeglia LM. Research review: what have we learned about adolescent substance use? J Child Psychol Psychiatry. 2018;59:618–27.CrossRefPubMed
2.
go back to reference Tam CL, Foo YC. A qualitative study on drug abuse relapse in Malaysia: contributory factors and treatment effectiveness. Int J Collab Res Intern Med Public Health. 2013;5:217–32. Tam CL, Foo YC. A qualitative study on drug abuse relapse in Malaysia: contributory factors and treatment effectiveness. Int J Collab Res Intern Med Public Health. 2013;5:217–32.
3.
go back to reference Gobel K, Scheithauer H, Braker AB, Jonkman H, Soellner R. Substance use patterns among adolescents in Europe: a latent class analysis. Subst Use Misuse. 2016;51:1130–8.CrossRefPubMed Gobel K, Scheithauer H, Braker AB, Jonkman H, Soellner R. Substance use patterns among adolescents in Europe: a latent class analysis. Subst Use Misuse. 2016;51:1130–8.CrossRefPubMed
4.
go back to reference Johnston LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE. Monitoring the future National Survey Results on drug use: 1975-2016: overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan; 2017. Johnston LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE. Monitoring the future National Survey Results on drug use: 1975-2016: overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan; 2017.
6.
go back to reference Hall WD, Patton G, Stockings E, Weier M, Lynskey M, Morley KI, Degenhardt L. Why young people's substance use matters for global health. Lancet Psychiatry. 2016;3:265–79.CrossRefPubMed Hall WD, Patton G, Stockings E, Weier M, Lynskey M, Morley KI, Degenhardt L. Why young people's substance use matters for global health. Lancet Psychiatry. 2016;3:265–79.CrossRefPubMed
7.
go back to reference Swahn MH, Bossarte RM, Choquet M, Hassler C, Falissard B, Chau N. Early substance use initiation and suicide ideation and attempts among students in France and the United States. Int J Public Health. 2012;57:95–105.CrossRefPubMed Swahn MH, Bossarte RM, Choquet M, Hassler C, Falissard B, Chau N. Early substance use initiation and suicide ideation and attempts among students in France and the United States. Int J Public Health. 2012;57:95–105.CrossRefPubMed
8.
go back to reference Jordan CJ, Andersen SL. Sensitive periods of substance abuse: early risk for the transition to dependence. Dev Cogn Neurosci. 2017;25:29–44.CrossRefPubMed Jordan CJ, Andersen SL. Sensitive periods of substance abuse: early risk for the transition to dependence. Dev Cogn Neurosci. 2017;25:29–44.CrossRefPubMed
9.
go back to reference Nociar A, Sieroslawski J, Csemy L. Substance use among European students: east - west comparison between 1995 and 2011. Cent Eur J Public Health. 2016;24:281–8.CrossRefPubMed Nociar A, Sieroslawski J, Csemy L. Substance use among European students: east - west comparison between 1995 and 2011. Cent Eur J Public Health. 2016;24:281–8.CrossRefPubMed
10.
go back to reference Peltzer K. Prevalence and correlates of substance use among school children in six African countries. Int J Psychol. 2009;44:378–86.CrossRefPubMed Peltzer K. Prevalence and correlates of substance use among school children in six African countries. Int J Psychol. 2009;44:378–86.CrossRefPubMed
12.
go back to reference El Omari F, Toufiq J. The Mediterranean school survey project on alcohol and other drugs in Morocco. Addicta: Turkish J Addictions. 2015;2:30–9. El Omari F, Toufiq J. The Mediterranean school survey project on alcohol and other drugs in Morocco. Addicta: Turkish J Addictions. 2015;2:30–9.
13.
go back to reference El Omari F, Salomonsen-Sautel S, Hoffenberg A, Anderson T, Hopfer C, Toufiq J. Prevalence of substance use among moroccan adolescents and association with academic achievement. World J Psychiatry. 2015;5:425–31.CrossRefPubMedPubMedCentral El Omari F, Salomonsen-Sautel S, Hoffenberg A, Anderson T, Hopfer C, Toufiq J. Prevalence of substance use among moroccan adolescents and association with academic achievement. World J Psychiatry. 2015;5:425–31.CrossRefPubMedPubMedCentral
14.
go back to reference Massad SG, Shaheen M, Karam R, Brown R, Glick P, Linnemay S, Khammash U. Substance use among Palestinian youth in the West Bank, Palestine: a qualitative investigation. BMC Public Health. 2016;16:800.CrossRefPubMedPubMedCentral Massad SG, Shaheen M, Karam R, Brown R, Glick P, Linnemay S, Khammash U. Substance use among Palestinian youth in the West Bank, Palestine: a qualitative investigation. BMC Public Health. 2016;16:800.CrossRefPubMedPubMedCentral
15.
go back to reference Tsering D, Pal R, Dasgupta A. Licit and illicit substance use by adolescent students in eastern India: prevalence and associated risk factors. J Neurosci Rural Pract. 2010;1:76–81.CrossRefPubMedPubMedCentral Tsering D, Pal R, Dasgupta A. Licit and illicit substance use by adolescent students in eastern India: prevalence and associated risk factors. J Neurosci Rural Pract. 2010;1:76–81.CrossRefPubMedPubMedCentral
16.
go back to reference Hodder RK, Freund M, Bowman J, Wolfenden L, Gillham K, Dray J, Wiggers J. Association between adolescent tobacco, alcohol and illicit drug use and individual and environmental resilience protective factors. BMJ Open. 2016;6:e012688.CrossRefPubMedPubMedCentral Hodder RK, Freund M, Bowman J, Wolfenden L, Gillham K, Dray J, Wiggers J. Association between adolescent tobacco, alcohol and illicit drug use and individual and environmental resilience protective factors. BMJ Open. 2016;6:e012688.CrossRefPubMedPubMedCentral
17.
go back to reference Peltzer K. Health behavior and protective factors among school children in four African countries. Int J Behav Med. 2009;16:172–80.CrossRefPubMed Peltzer K. Health behavior and protective factors among school children in four African countries. Int J Behav Med. 2009;16:172–80.CrossRefPubMed
18.
go back to reference Escobar OS, Vaughan EL. Public religiosity, religious importance, and substance use among Latino emerging adults. Subst Use Misuse. 2014;49:1317–25.CrossRefPubMed Escobar OS, Vaughan EL. Public religiosity, religious importance, and substance use among Latino emerging adults. Subst Use Misuse. 2014;49:1317–25.CrossRefPubMed
19.
go back to reference Alhyas L, Al Ozaibi N, Elarabi H, El-Kashef A, Wanigaratne S, Almarzouqi A, Alhosani A, Al Ghaferi H. Adolescents’ perception of substance use and factors influencing its use: a qualitative study in Abu Dhabi. JRSM Open. 2015;6:1–12.CrossRef Alhyas L, Al Ozaibi N, Elarabi H, El-Kashef A, Wanigaratne S, Almarzouqi A, Alhosani A, Al Ghaferi H. Adolescents’ perception of substance use and factors influencing its use: a qualitative study in Abu Dhabi. JRSM Open. 2015;6:1–12.CrossRef
20.
go back to reference Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav: the official publication of the Society for Public. Health Educ. 2012;39:364–72. Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav: the official publication of the Society for Public. Health Educ. 2012;39:364–72.
21.
go back to reference Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet. 2002;360:1083–8.CrossRefPubMed Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet. 2002;360:1083–8.CrossRefPubMed
23.
go back to reference Zarrouq B, Bendaou B, El Asri A, Achour S, Rammouz I, Aalouane R, Lyoussi B, Khelafa S, Bout A, Berhili N, et al. Psychoactive substances use and associated factors among middle and high school students in the north Center of Morocco: a cross-sectional questionnaire survey. BMC Public Health. 2016;16:468.CrossRefPubMedPubMedCentral Zarrouq B, Bendaou B, El Asri A, Achour S, Rammouz I, Aalouane R, Lyoussi B, Khelafa S, Bout A, Berhili N, et al. Psychoactive substances use and associated factors among middle and high school students in the north Center of Morocco: a cross-sectional questionnaire survey. BMC Public Health. 2016;16:468.CrossRefPubMedPubMedCentral
25.
go back to reference Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 5th ed. Thousand Oaks, CA: SAGE Publications; 2014. Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 5th ed. Thousand Oaks, CA: SAGE Publications; 2014.
26.
go back to reference El Achhab Y, El Ammari A, El Kazdouh H, Najdi A, Berraho M, Tachfouti N, Lamri D, El Fakir S, Nejjari C. Health risk behaviours amongst school adolescents: protocol for a mixed methods study. BMC Public Health. 2016;16:1209.CrossRefPubMedPubMedCentral El Achhab Y, El Ammari A, El Kazdouh H, Najdi A, Berraho M, Tachfouti N, Lamri D, El Fakir S, Nejjari C. Health risk behaviours amongst school adolescents: protocol for a mixed methods study. BMC Public Health. 2016;16:1209.CrossRefPubMedPubMedCentral
27.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
28.
go back to reference Bronfenbrenner U. The ecology of human development. Cambridge: Harvard University Press; 1979. Bronfenbrenner U. The ecology of human development. Cambridge: Harvard University Press; 1979.
29.
go back to reference Ungar M, Ghazinour M, Richter J. Annual research review: what is resilience within the social ecology of human development? J Child Psychol Psychiatry. 2013;54:348–66.CrossRefPubMed Ungar M, Ghazinour M, Richter J. Annual research review: what is resilience within the social ecology of human development? J Child Psychol Psychiatry. 2013;54:348–66.CrossRefPubMed
30.
go back to reference Skrzypiec G, Owens L. Drug taking beliefs of Australian adolescents: a pilot study. J Drug Educ. 2013;43:1–18.CrossRefPubMed Skrzypiec G, Owens L. Drug taking beliefs of Australian adolescents: a pilot study. J Drug Educ. 2013;43:1–18.CrossRefPubMed
31.
go back to reference McClafferty KAE, Torres CAE, Mitchell TRE. Challenges of urban education: sociological perspectives for the next century. Albany: State University of New York Press; 2000. McClafferty KAE, Torres CAE, Mitchell TRE. Challenges of urban education: sociological perspectives for the next century. Albany: State University of New York Press; 2000.
32.
go back to reference Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ, US: Prentice-Hall; 1986. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ, US: Prentice-Hall; 1986.
33.
go back to reference Alhyas L, Elarabi H, El-Kashef A, Wanigaratne S, Almarzouqi A, Alhosani A, Al Ghaferi H. Parents’ perceptions and beliefs on adolescence and substance use: a preliminary qualitative study in Abu Dhabi, United Arab Emirates [UAE]. J Child Adolesc Behav. 2015;3:195. Alhyas L, Elarabi H, El-Kashef A, Wanigaratne S, Almarzouqi A, Alhosani A, Al Ghaferi H. Parents’ perceptions and beliefs on adolescence and substance use: a preliminary qualitative study in Abu Dhabi, United Arab Emirates [UAE]. J Child Adolesc Behav. 2015;3:​195.
34.
go back to reference Zarrouq B, Bendaou B, Elkinany S, Rammouz I, Aalouane R, Lyoussi B, Khelafa S, Bout A, Berhili N, Hlal H, et al. Suicidal behaviors among Moroccan school students: prevalence and association with socio-demographic characteristics and psychoactive substances use: a cross-sectional study. BMC Psychiatry. 2015;15:284.CrossRefPubMedPubMedCentral Zarrouq B, Bendaou B, Elkinany S, Rammouz I, Aalouane R, Lyoussi B, Khelafa S, Bout A, Berhili N, Hlal H, et al. Suicidal behaviors among Moroccan school students: prevalence and association with socio-demographic characteristics and psychoactive substances use: a cross-sectional study. BMC Psychiatry. 2015;15:284.CrossRefPubMedPubMedCentral
35.
go back to reference Smith LL, Yan F, Charles M, Mohiuddin K, Tyus D, Adekeye O, Holden KB. Exploring the link between substance use and mental health status: what can we learn from the self-medication theory? J Health Care Poor Underserved. 2017;28:113–31.CrossRefPubMed Smith LL, Yan F, Charles M, Mohiuddin K, Tyus D, Adekeye O, Holden KB. Exploring the link between substance use and mental health status: what can we learn from the self-medication theory? J Health Care Poor Underserved. 2017;28:113–31.CrossRefPubMed
37.
go back to reference Talip T, Kifli N, Murang Z, Naing L. Smoking initiation and continuation a qualitative study among Bruneian male adolescents. Asian Pac J Cancer Prev. 2016;17:3533–40.PubMed Talip T, Kifli N, Murang Z, Naing L. Smoking initiation and continuation a qualitative study among Bruneian male adolescents. Asian Pac J Cancer Prev. 2016;17:3533–40.PubMed
38.
go back to reference Nunez-Smith M, Wolf E, Huang HM, Chen PG, Lee L, Emanuel EJ, Gross CP. Media exposure and tobacco, illicit drugs, and alcohol use among children and adolescents: a systematic review. Subst Abus. 2010;31:174–92.CrossRefPubMed Nunez-Smith M, Wolf E, Huang HM, Chen PG, Lee L, Emanuel EJ, Gross CP. Media exposure and tobacco, illicit drugs, and alcohol use among children and adolescents: a systematic review. Subst Abus. 2010;31:174–92.CrossRefPubMed
39.
go back to reference Secor-Turner M, Randall BA, Mudzongo CC. Barriers and Facilitators of adolescent health in rural Kenya. J Transcult Nurs. 2016;27:270–6.CrossRefPubMed Secor-Turner M, Randall BA, Mudzongo CC. Barriers and Facilitators of adolescent health in rural Kenya. J Transcult Nurs. 2016;27:270–6.CrossRefPubMed
40.
go back to reference Moilanen KL, Markstrom CA, Jones E. Extracurricular activity availability and participation and substance use among American Indian adolescents. J Youth Adolesc. 2014;43:454–69.CrossRefPubMed Moilanen KL, Markstrom CA, Jones E. Extracurricular activity availability and participation and substance use among American Indian adolescents. J Youth Adolesc. 2014;43:454–69.CrossRefPubMed
41.
go back to reference Igra V, Irwin CE. Theories of adolescent risk-taking behavior. In: DiClemente RJ, Hansen WB, Ponton LE, editors. Handbook of adolescent health risk behavior. Boston: Springer US; 1996. p. 35–51.CrossRef Igra V, Irwin CE. Theories of adolescent risk-taking behavior. In: DiClemente RJ, Hansen WB, Ponton LE, editors. Handbook of adolescent health risk behavior. Boston: Springer US; 1996. p. 35–51.CrossRef
43.
go back to reference McLaughlin A, Campbell A, McColgan M. Adolescent substance use in the context of the family: a qualitative study of young People's views on parent-child attachments, parenting style and parental substance use. Subst Use Misuse. 2016;51:1846–55.CrossRefPubMed McLaughlin A, Campbell A, McColgan M. Adolescent substance use in the context of the family: a qualitative study of young People's views on parent-child attachments, parenting style and parental substance use. Subst Use Misuse. 2016;51:1846–55.CrossRefPubMed
44.
go back to reference Calafat A, Garcia F, Juan M, Becona E, Fernandez-Hermida JR. Which parenting style is more protective against adolescent substance use? Evidence within the European context. Drug Alcohol Depend. 2014;138:185–92.CrossRefPubMed Calafat A, Garcia F, Juan M, Becona E, Fernandez-Hermida JR. Which parenting style is more protective against adolescent substance use? Evidence within the European context. Drug Alcohol Depend. 2014;138:185–92.CrossRefPubMed
45.
go back to reference Mayberry ML, Espelage DL, Koenig B. Multilevel modeling of direct effects and interactions of peers, parents, school, and community influences on adolescent substance use. J Youth Adolesc. 2009;38:1038–49.CrossRefPubMed Mayberry ML, Espelage DL, Koenig B. Multilevel modeling of direct effects and interactions of peers, parents, school, and community influences on adolescent substance use. J Youth Adolesc. 2009;38:1038–49.CrossRefPubMed
46.
go back to reference Jovic-Vranes AS, Vranes B, Marinkovic J, Cucic V. Adolescent substance abuse, the importance of family, school and peers: data from the health behaviour in school children. Soz Präventivmed. 2005;50:119–24.CrossRefPubMed Jovic-Vranes AS, Vranes B, Marinkovic J, Cucic V. Adolescent substance abuse, the importance of family, school and peers: data from the health behaviour in school children. Soz Präventivmed. 2005;50:119–24.CrossRefPubMed
48.
go back to reference Beckmeyer JJ. Comparing the associations between three types of adolescents’ romantic involvement and their engagement in substance use. J Adolesc. 2015;42:140–7.CrossRefPubMed Beckmeyer JJ. Comparing the associations between three types of adolescents’ romantic involvement and their engagement in substance use. J Adolesc. 2015;42:140–7.CrossRefPubMed
49.
go back to reference Leahy D, Schaffalitzky E, Armstrong C, Latham L, McNicholas F, Meagher D, Nathan Y, O’Connor R, O’Keane V, Ryan P, et al. How social context impacts on the development, identification and treatment of mental and substance use disorders among young people – a qualitative study of health care workers. Ir J Psychol Med. 2015;32:117–28.CrossRefPubMed Leahy D, Schaffalitzky E, Armstrong C, Latham L, McNicholas F, Meagher D, Nathan Y, O’Connor R, O’Keane V, Ryan P, et al. How social context impacts on the development, identification and treatment of mental and substance use disorders among young people – a qualitative study of health care workers. Ir J Psychol Med. 2015;32:117–28.CrossRefPubMed
50.
go back to reference Eisenberg ME, Toumbourou JW, Catalano RF, Hemphill SA. Social norms in the development of adolescent substance use: a longitudinal analysis of the international youth development study. J Youth Adolesc. 2014;43:1486–97.CrossRefPubMedPubMedCentral Eisenberg ME, Toumbourou JW, Catalano RF, Hemphill SA. Social norms in the development of adolescent substance use: a longitudinal analysis of the international youth development study. J Youth Adolesc. 2014;43:1486–97.CrossRefPubMedPubMedCentral
51.
go back to reference Gryczynski J, Ward BW. Social norms and the relationship between cigarette use and religiosity among adolescents in the United States. Health Educ Behav : the official publication of the Society for Public. Health Educ. 2011;38:39–48. Gryczynski J, Ward BW. Social norms and the relationship between cigarette use and religiosity among adolescents in the United States. Health Educ Behav : the official publication of the Society for Public. Health Educ. 2011;38:39–48.
Metadata
Title
Adolescents, parents and teachers’ perceptions of risk and protective factors of substance use in Moroccan adolescents: a qualitative study
Authors
Hicham El Kazdouh
Abdelghaffar El-Ammari
Siham Bouftini
Samira El Fakir
Youness El Achhab
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Substance Abuse Treatment, Prevention, and Policy / Issue 1/2018
Electronic ISSN: 1747-597X
DOI
https://doi.org/10.1186/s13011-018-0169-y

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