Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697649071702.pdf (Bahamas)
BBaahhaammaass SSeeccoonnddaarryy SScchhooooll DDrruugg PPrreevvaalleennccee SSuurrvveeyy 22001122 EExxeeccuuttiivvee SSuummmmaarryy National Anti-Drug Secretariat Ministry of National Security For further information relative to this report, contact: National Anti-Drug Secretariat Ministry of National Security P.O.
Box N-3217 Church House Complex East St. & Sands Lane Nassau, Bahamas Telephone: (242) 326-4118, 4123 Fax: (242) 326-1462 Email: terrancefountain@bahamas.gov.bs ii Table of Contents Acknowledgements …………………………………………………………………… v Glossary of Terms………..…………………………………………………….……… vi Survey Management Team ………………………………………………………….. vii 1.

2.

Introduction..…………………………………………………………………… 1 Methods..……………………………………………..……………….…..…….

3 2.1.

Study Design ………………………………………………………..… 3 2.2.


Sample Selection……………………………………………………… 3 3 2.3.

Data Collection and Analysis ………………………………….….… 3.

Drug Highlights …………………………………………………….……..…… 5 3.1.

Student Demographics …………………………………………..…… 5 3.2.

Cigarettes …………………………………………………………….… 5 3.3.

Alcohol …………………………………………………………….…… 7 3.4.

Marijuana …………………………………………………………….… 11 3.5.

Solvent and Inhalant Use ………………………………………..…… 13 3.6.

Other Drug Use ………………………………………………….…….. 14 3.7.


Average Age of First Use ………………………………………….….. 14 3.8.

Exposure to Various Substances and Other External Influences …………………………………………………………….… 15 3.9.

Student Predisposition to Substance Use and Perception of the Risk of Taking Selected Substances………………………….

18 4.

Highlights of Behaviors Associated with Violence and Unintentional Injuries ……………………………………………………………………….… 21 4.1.

Physical Attacks and Fights……………………………………..…… 21 4.2.
Serious Injury ………………………………..………………………… 22 4.3.

Bullying ………………………………………………………………… 22 4.4.

Weapon Carrying and Other Safety Issues..……………………..… 23 4.5.

Abuse and Other Signs or Acts of Violence………………………… 23 iii 5.

Students’ Mental Health and Other Risk and Protective Factors…….…… 25 5.1.

Mental Health ……………………………………………………….….

25 5.2.

Risk and Protective Factors ………………………………..…....…… 26 6.

Conclusions and Recommendations ……….……………………………….

28 6.1.

Policy Recommendations………………………………………..…… 28 6.2.


Programmatic Recommendations…………………………………… 29 6.3.

Recommendations for Future Research .…………………………… 30 iv Acknowledgements A survey of this magnitude requires the cooperation and support of many individuals and groups that are integral to the success of such a project.
First and foremost, thanks is expressed to the Government of The Bahamas for having the foresight to continue conducting these surveys and for agreeing to fund the 2011 Secondary School Drug Prevalence Survey with funds made available from the Confiscated Assets Fund.
Special recognition is given to Mr. Terrance Fountain, Principal Researcher, and other members of the staff of the National Anti-Drug Secretariat; most notably, Carla Johnson-Toote, for the administration and coordination of all survey activities.

The Ministry also recognizes the facilitators, supervisors and all other persons involved in the collection, handling and analysis of the data, as well as the drafting and editing of the report for the invaluable role that they played in completing this project.
Without their dedication, this would not have been possible.

Finally, and most importantly, a special debt of gratitude is extended to all of the various educational authorities, school boards, principals, parents and students that played a major role in ensuring the representativeness and success of this project.

Without the level of cooperation extended, there would have been no survey.

Again, the Ministry gratefully acknowledges the support of all.
Ministry of National Security 2012 v Glossary of Terms Prevalence Indicators Lifetime Last Year Last Month Current Use The use of a substance at any point in the students’ life; whether it was 10 years ago, last year, last month or yesterday; The use of a substance within the 12 months immediately preceding the survey; The use of a substance within the four weeks immediately preceding the survey; and Prevalence in the last month.

Binge drinking Had 5+ drinks on one occasion.
Categorization of Substances The drug categories used in this report are identical to the categories used in the questionnaire and follow the descriptions and examples provided to students, as follows: Alcohol Cocaine Ecstasy Hallucinogens Inhalants Marijuana Opiates Stimulants Tranquillizers Tobacco Beer, wine, wine coolers, spirits, liqueurs, sherry or port; Cocaine or crack; Ecstasy or XTC, E, MDMA, EX; LSD, acid; Substance deliberately sniffed (inhaled) in order to get high; e.g.
: glue, paint, white out, petrol or paint thinners; Marijuana, ganja, grass, weed, cannabis, dope, pot or joint; Heroin, or other narcotics such as methadone, morphine or pethidine.

Amphetamines or speed, uppers, MDA.

Sleeping tablets, or sedatives.
Cigarettes, Beedis, Black & Mild, Backwoods vi Survey Management Team Terrance Fountain - Principal Investigator Field Coordinators New Providence Carla Johnson-Toote – National Anti-Drug Secretariat Grand Bahama Michelle Lundy – Psychologist, Rand Memorial Hospital Other Members - Core Planning Committee  Nanika V. Brathwaite – Health Information and Research Unit, Ministry of Health  Tyrone Johnson – Adolescent Health Unit, Ministry of Health  Vincente Roberts – College of The Bahamas  Ingrid Deveaux – Ministry of Youth  Zoe Powell – Ministry of Education  Sabrina Skinner – Ministry of Education  Dr. Bridgette Rolle – Bahamas National Drug Council  Paul Williams – Bahamas National Drug Council  Marian Pinder - Bahamas National Drug Council  Jestina Rigby – Drug Enforcement Unit, Royal Bahamas Police Force  Dr. Anthony Frankson – School of Clinical Medicine and Research, University of the West Indies Facilitators New Providence  Ayesha Davis-Finlayson  Marvin Hepburn  Gayle Hamilton  Floyd McPhee  Valarie Minus  Nanika Brathwaite  Aurelius Jordan  Donelle Musgrove vii  Shervin Lloyd  Carla Toote  Derek Musgrove  Godfrey Rolle  Michelle Knowles  Siobhane Deane  David Ramsey  Terrance Fountain  Vandesa Rodgers Grand Bahama  Michelle Virgill  Clarence Hield  Vernae Hunt  Dillette Thompson  Lakisha Russell  Keira Cox Editorial Team  Terrance Fountain  Brittny Major viii 1.
Introduction Bahamian adolescents are faced with various challenges that seem to only grow with subsequent generations and which the adults of today, drawing on their own experiences, are only partially aware of.
To compound the required pressures of school work, adolescents are bombarded with their budding sexuality, physical changes, the desire to conform to peers and yet be different, strained relationships with adults, and a growing, but still immature understanding of their individuality and self-awareness.

These universal challenges that every young person face are reflected in common behavior patterns, and while most pass through these years to emerge as healthy adults, others succumb.
The routine monitoring of the prevalence of psychotropic substance use provides current information on trends that can be used in the planning, implementation and evaluation of school, community and national level interventions intended to reduce and/or prevent the use and abuse of licit and illicit substances.
This information is imperative as effective prevention requires that relevant and consistent messages encouraging healthy choices be delivered by multiple messengers repeatedly throughout childhood and adolescence1.

These should include key stakeholders such as the schools, parents, peers, and the community that all have a critical role to play in the development of young persons and in the determination of whether they will try drugs.
This report contains the findings of a survey conducted in Bahamian Secondary Schools during 2011.

The survey was the third in a series of surveys conducted using the methodology devised by the Inter-American Drug Control Commission under its SIDUC program; the first having been completed in 20022 and the second in 2008.
In the 2008 study, it was determined that alcohol was, by far, the drug of choice of Bahamian secondary school students, with approximately one-half (49.3%) of all students and two-thirds (67.9%) of all 12th graders using in the past year, and 42.4% of all 12th graders using within the past month.

Alcohol use was followed by the use of marijuana, which was the most widely used of the illicit drugs.
This was no surprise as the United Nations Office on Drugs and Crime’s (UNODC) 2012 World Drug Report revealed that in 2010 cannabis was still the most widely consumed illicit drug worldwide with an annual prevalence estimated between 2.6% and 5%.

A total of 1 of every 5 (21.8%) of the 12th grade students had tried marijuana and overall more had used it within the past year and past month than had smoked cigarettes.
With respect to those factors that increased the likelihood of drug use, the 2002 survey revealed that being male, older, curious about trying illicit drugs, holding the view that smoking marijuana “sometimes” was only “slightly harmful” or “not harmful”, having 1 Preventing Adolescent Substance Abuse, Research Update.

May, 2000 2 Health Information and Research Unit, Ministry of Health.

Secondary School Drug Prevalence Survey, 2003.


1 “some” or “a lot” of friends that used, finding it “very easy” to access drugs, having smoked cigarettes in the past 12 months, or having experienced academic problems “once” or having been disciplined for behavioral problems “often or a lot” were all significant independent correlates of experimentation with marijuana at least once in the students’ life.
The initial goal of the 2011 survey was to provide a complete assessment of the drug situation among adolescent girls and boys, as part of an assessment of needs and priorities for youth-oriented drug prevention programs.

While the SIDUC method calls for no major changes to be made to the drug questionnaire, it does allow for additional questions to be appended, based on the current information priorities of the stakeholder agencies.
For the 2011 survey, the decision was taken to include questions to assess the level of and exposure to violence in and among Bahamian secondary school students and other risk and protective factors.
As a result, the specific objectives of this survey were:  To determine the prevalence of alcohol and cigarette use;  To determine the extent to which students use and/or abuse prescription drugs;  To determine the prevalence of illicit substance use;  To determine the association between the use of these psychotropic substances and other risk and protective factors;  To determine the prevalence of acts of violence and their consequences such as abuse, physical attacks, fights, bullying, injuries, etc;  To determine the prevalence of other violence-related practices such as weapon carrying;  To determine the extent to which students engage in risky behaviors;  To determine the level of exposure to school-based prevention programs and other violence-related risk and protective factors; and  To determine the relations with parents and the level of involvement of parents in the lives of the students.
2 2.

Methods 2.1.

Study Design The survey was a general population-based cross sectional survey and, as such, collected information on both potential risks and outcomes at the same point in time.

This could be equated to a snapshot of the current situation both with respect to outcomes and possible risk and/or protective factors.

2.2.
2.2.

Sample Selection The selection of islands targeted for the survey was based on a combination of convenience and economics and included the 7 most populated islands of the Bahamas.

Together, these islands accounted for approximately 96.9% of the total population (2010 Census).

To be consistent with the SIDUC methodology and to allow for a fairly broad age representation, the survey included students in grades 8, 10 and 12 from both public as well as private schools.
Once a class was selected, all students in the selected classes anonymously completed a self-administered, pre-coded questionnaire.

2.3.

Data Collection and Analysis The survey collected data on the use of illicit drugs and other psychotropic substances, violence and associated risk and protective factors.

The drugs included tobacco; alcohol; tranquilizers; stimulants; marijuana; hashish; cocaine hydrochloride; crack cocaine; ecstasy; hallucinogens; heroin; opium; morphine; and inhalants.
Drug usage was measured through three primary indicators:  Lifetime prevalence – The use of a substance at any point in the students’ life; whether it was 10 years ago, last year, last month or yesterday;  Prevalence in the last year – The use of a substance within the 12 months immediately preceding the survey; and  Prevalence in the last month – The use of a substance within the four weeks immediately preceding the survey.
In addition to the drug prevalence data, information was also collected on risk and protective factors related to drug use such as the students’ family composition, exposure to drugs and alcohol through friends and the community, academic performance, personal opinions about the danger of using certain drugs, personal predisposition to drug use, and parental problems.
3 The data related to violence and unintentional injuries included information on abuse; bullying; physical attacks and associated injuries; weapon carrying and on other risky behavior and protective factors; Prevention education; and the students’ mental health.

The data was entered and analyzed with the use of the statistical software SPSS (Ver.

17.0).

4 3.

Drug Highlights 3.1.


Student Demographics The final analysis was performed on a total of 2639 students selected from 113 classes in 44 educational institutions across 7 islands.

The majority of the students were female (51.5%), from the 10th grade (35.6%), enrolled in public schools (71.7%) and from the island of New Providence (68.0%)(Table 1).
Table 1: Student Demographics Demographic Indicator Distribution of Students Percent Number Gender Males Females Grade in School 8th 10th 12th Age Groups Islands 10 – 12 Yrs 13 - 14 Yrs 15 – 16 Yrs 17 Yrs and Over New Providence Grand Bahama Abaco Andros Eleuthera Exuma Long Island Type of School Public Private Cigarettes 3.2.1.
Cigarettes 3.2.1.

Overview The use of cigarettes decreased significantly for Lifetime use when compared to the 2002 Survey but was similar to the rate observed in 2008.

Rates of use in the past year and use in the 30 days immediately preceding the survey increased since 2008 (Figure 1).

5  Approximately 13.1% of all students smoked a cigarette at least once during their lifetime; as compared to 19.8% in 2002 and 12.9% in 2008.
 Overall, only 5.1% had smoked a cigarette in the year preceding the survey, up from the 3.5% in 2008.

 2.3% smoked within the past month; as compared to 2.2% in 2002 and 1.6% in 2008.

 Of those who smoked in the past month: o 37.5% did not smoke everyday while 41.1% smoked between 1-5 cigarettes per day; o One-quarter (24.0%) smoked most often at home, 30.0% while on the block and another 16% at a friend’s house.
Figure 1: Table 2: Prevalence of Cigarette Smoking by Gender and By Grade Level Selected Demographic Factors Lifetime Gender Grade Level Females Males Total Grade 8 Grade 10 Grade 12 10.6 15.6 13.1 10.4 14.2 14.8 6 Prevalence Last 12 Months 4.0 6.3 5.1 4.0 5.4 6.2 Last 30 Days 1.3 3.3 2.3 1.7 2.5 2.6 Trend in the Prevalence of Cigarette Use Among Secondary School Students19.85.52.212.93.51.613.15.12.30510152025LifetimeLast 12 MonthsLast 30 DaysPercent (%)200220082011 Results by gender and grade revealed that: o Males (15.6%) were more likely to experiment with cigarettes than females (10.6%); o Lifetime prevalence increased with an increase in grade level; from 10.4% in grade 8 to 14.8% among 12th graders (Table 2).
3.2.1.

Main Source of Cigarettes Overall, approximately 42.3% “usually” got their cigarettes from friends while 28.8% usually purchased them from a store (Table 3) .

When the main source of the cigarettes were looked at by grade level, it was observed that as grade level increased, so did the percentage of students who got their cigarettes from a store.

Conversely, there was a drastic and consistent decrease in the percentage that got their cigarettes from friends with increasing grade level.
 0% of 8th graders usually got their cigarettes from a shop as compared to 28.6% of 10th graders and 47.4% of 12th graders.

 66.7% of 8th graders usually got their cigarettes from friends as compared to 47.6% of 10th graders and 21.1% of 12th graders.
Table 3: Main Source of Cigarettes by Grade Level Main Source Friends Parents Brother/Sister Other Relative Street Vendor Shop Other Total 8th 66.7 0.0 0.0 0.0 16.7 0.0 16.7 100 Grade Level 10th 47.6 0.0 4.8 4.8 0.0 28.6 14.3 100 12th 21.1 10.5 0.0 10.5 0.0 47.4 10.5 100 Total 42.3 3.8 1.9 5.8 3.8 28.8 13.5 100 3.3.

Alcohol 3.3.1.
Alcohol 3.3.1.

Overview The use of alcohol remains popular among Bahamian secondary school students with usage rates showing a consistent increase between 2002 and 2011 for each of the three prevalence indicators (Figure 2).

 Overall Lifetime usage was 70.0%; a slight increase from the 68.2% observed in 2008 and the 64.4% in 2002; 7  A total of 29.9% drank an alcoholic beverage within the past month; slightly up from the 22.6% in 2002 and the 28.9% in 2008.
Figure 2:  Results by gender revealed that for the first time in recent years, the prevalence of alcohol consumption in females surpassed those for males for all 3 prevalence indicators; although only slightly (Table 4).

o Male lifetime usage was 68.9%, as compared to 71.1% for females; 30.6% of all females used in the past month, as compared to 29.3% of males.
 Drinking rates increased consistently with grade level for all indicators; o 42.3% of 12th grade students drank within the past month, as compared to 15.1% of the grade 8 students.
Table 4: Prevalence of Alcohol Use by Gender and by Grade Level Prevalence Last 12 Months 51.7 48.5 50.0 30.6 55.7 65.3 Last 30 Days 30.6 29.3 29.9 15.1 33.4 42.3 Selected Factors Lifetime Gender Grade Level Females Males Total Grade 8 Grade 10 Grade 12 71.1 68.9 70.0 56.7 75.2 79.0 8 Trend in the Prevalence of Alcohol Use Among Secondary School Students64.443.922.668.249.328.9705029.9020406080100LifetimeLast 12 MonthsLast 30 DaysPercent (%)200220082011 3.3.2.
Binge Drinking Students who had taken a drink within the past 30 days were asked about the incidence of binge drinking within the past 2 weeks.

Binge drinking was defined as drinking five or more drinks on any one occasion.
 Results revealed that while 46.8% of those who drank within the month prior to the survey had not binged in the past two weeks, conversely, a total of 53.2% of the students who did drink had engaged in one or more sessions of binge drinking in the two weeks preceding the survey; o 21.3% once only; 17.0% between 2-3 times; and 14.8% four or more times.
There was no significant difference in the overall or grade-specific incidence of binge drinking between males and females who drank within the last 30 day, even though small differences were observed (Figure 3).

Overall, 55.2% of the males who drank within the past month had binged, as compared to 50.6% of the females.

 Grade 10 females engaged in binge drinking more often than their male counterparts (females 66.0%; males 54.1%).
 Grade 8 males engaged in binge drinking more than the females; (females 57.8%; males 66.7%).

 Among grade 12 students, 51.8% of the males and 43.9% of the females, admittedly, binged at least once within the past 2 weeks.

Figure 3: 9 Incidence of Binge Drinking By Grade Level and Sex Among Persons who Drank in Last 30 Days57.86643.966.754.151.862.255.547.6020406080Grade 8Grade 10Grade 12Percent (%)FemaleMaleTotal 3.3.3.
Place Where Students Drink Of those who drank in the 30 days immediately preceding the survey, the place where drinking took place most often was at social events and at home (Table 5).

 Approximately one-half (48.6%) of all students who drank within the past year did so most often at “Other Social Events”;  22.4% drank most often at home.
Table 5: Students who Drank within the Past 30 Days: Location Where Students Drink Alcoholic Beverages Most Often by Grade Level Primary Smoking Location At Home At School On the Corner/Block At a Friend’s House At Sporting Events At Other Social Events Other Total 8th 36.6 1.6 5.7 9.8 3.3 23.6 19.5 100 Grade Level 10th 26.7 1.8 4.4 8.8 4.8 38.1 15.4 100 12th 12.8 1.0 2.6 3.0 1.3 68.1 11.2 100 Total 22.4 1.4 3.9 6.4 3.0 48.6 14.3 100 Of interest was that while the percentage who drank most often at home decreased as grade level increased, the percentage who most often drank at other social events increased with an increase in grade level.
 36.6% of the 8th graders drank mostly at home as compared to 26.7% and 12.8% of the 10th and 12th graders, respectively;  Conversely, whereas only 23.6% of the 8th graders mostly drank at other social events, this increased to 38.1 among 10th graders and to 68.1% among 12th graders.

3.3.4.

Source of Alcohol Those students who admittedly drank within the year preceding the survey were asked to state from where they usually got their alcohol.
The primary source of alcohol for these students was:  Friends – 25.4%; Shop – 20.4%; Other Relative -18.6%; and Parents -12.5% (Table 6).

Of interest was the inverse association with the percentage who indicated parents as the main source and grade level.

 This percent decreased from a high of 17.1% among 8th graders to 10.6 among 10th graders and to 6.1% among 12th graders.
10 Table 6: Students who Drank within the Past 30 Days: Main Source of Alcoholic Beverage by Grade Level Main Source Friends Parents Brother/Sister Other Relative Street Vendor Shop Other Total 8th 24.8 17.1 7.7 25.6 4.3 8.5 12.0 100 Grade Level 10th 24.0 10.6 8.7 23.2 1.9 17.1 14.4 100 12th 26.9 6.1 7.4 11.8 2.7 27.9 17.2 100 Total 25.4 9.7 8.0 18.6 2.7 20.4 15.2 100 3.4.

Marijuana 3.4.1.
Marijuana 3.4.1.

Overview Compared to 2008, marijuana usage rates increased with more students having tried marijuana and more continuing to use (Figure 4).

 13.7% of all students had tried marijuana at least once in their lifetime, with 9.7% having used within the past year and 5.0% in the 30 days immediately preceding the survey; o Usage rates in 2008 were 12.7% lifetime, 7.2% in the past year and 3.4% in the past month.
 Of those who did admit to smoking marijuana within the past year, 28.2% did so only once; 32.7% occasionally; and another 28.6% on a weekly or more frequent basis.

Figure 4: 11 Trend in the Prevalence of Marijuana Use Among Secondary School Students14.48.34.712.77.23.413.79.750510152025LifetimeLast 12 MonthsLast 30 DaysPercent (%)200220082011 Marijuana usage rates by gender and grade level revealed that there were still pockets of users that continue to be a cause of concern.
 Overall, males use marijuana at more than double the rate of their female counterparts and 12th graders used at almost four times the rate as did the 8th graders; o 18.7% of all males had tried and 7.4% had used in the past 30 days as compared to 8.7% and 2.8% in females, respectively; o 20.0% of all 12th graders had tried and 14.0% used in the past year as compared to 5.9% and 4.1% among 8th graders, respectively;  28.2% of all 12th grade males had tried marijuana at least once in their lifetime, while 20.3% had used within the past 12 months and 10.6% in the last 30 days (Table 7).
Table 7: Prevalence of Marijuana Use by Gender and by Grade Level Selected Factors Gender Grade Level Males Females Total Grade 8 Grade 10 Grade 12 Lifetime 18.7 8.7 13.7 5.9 16.2 20.0 Prevalence Last 12 Months 13.2 6.3 9.7 4.1 11.7 14.0 Last 30 Days 7.4 2.8 5.0 1.5 6.8 7.1 3.4.2.
Place Where Students Smoke Marijuana Of those who smoked marijuana in the 12 months immediately preceding the survey, the place where they went to use most often was on the corner or block of their neighborhood (31.7%), at home (19.8%) or at a friend’s house (18.9%) (Table 8).
Table 8: Students who Used Within the Past 12 months: Location Where Students Smoked Marijuana Most Often by Grade Level Primary Smoking Location At Home At School On the Corner/Block At a Friend’s House At Other Social Events Other Total Grade Level 10th 17.3 7.1 35.7 16.3 10.2 13.2 100 12th 20.0 4.2 26.3 22.1 12.6 14.7 100 Total 19.8 5.3 31.7 18.9 10.6 13.7 100 8th 26.5 2.9 35.3 17.6 5.9 11.8 100 12 3.4.3.
Source of Marijuana The primary source of marijuana for those students who admittedly smoked within the year preceding the survey was from friends (50.2%) or street pushers (22.1%) (Table 9).

No real or consistent differences were observed between the source of marijuana and grade level.
Table 9: Students who Used Within the Past 12 months: Main Source of Marijuana by Grade Level Main Source Friends Parents Brother/Sister Other Relative Street Pusher Other Total 8th 53.1 0.0 6.3 9.4 9.4 21.9 100 Grade Level 10th 46.5 0.0 6.9 6.9 24.8 14.9 100 12th 53.1 3.1 2.0 8.2 23.5 10.2 100 Total 50.2 1.3 4.8 7.8 22.1 13.9 100 3.5.

Solvents and Inhalants After alcohol, cigarettes and marijuana, the substance tried most often by the students was solvents and inhalants.
Results are displayed in Table 10.

 10.2% or 1 of every 10 students reportedly tried a solvent or inhalant at least once in their lives; an increase from the 5.4% observed in 2008;  Only 4.4% had used a solvent in the past year and 2.0% within the past 30 days.

While apparent differences at all levels were observed, there was no significant difference in the proportion of males and females who used a solvent or inhalant at least once in their lives or in the past year.
However, the difference was significant for use in the past 30 days; Table 10: Prevalence of Solvent or Inhalant Use by Gender and by Grade Level Selected Factors Lifetime Gender Grade Level Females Males Total Grade 8 Grade 10 Grade 12 11.0 9.4 10.2 9.9 12.6 7.7 13 Prevalence Last 12 Months 5.1 3.7 4.4 5.1 5.8 1.9 Last 30 Days 2.6 1.4 2.0 2.0 2.9 1.0 Regarding the frequency of use, 35.6% of all students who used within the past year had used it only once; 28.8% “occasionally”; 19.2% weekly; and another 7.7% daily; With many of these substances being legal household substances, it was no surprise to find that a total of 42.0% of those using a solvent or inhalant in the past year indicated that they got the substance from inside their homes.
3.6.

Other Drug Use The abuse of prescription drugs, both tranquilizers and stimulants, was not common among Bahamian secondary school students (Table 11).

 A total of 3.8% had tried tranquilizers at least once while 2.7% had experimented with stimulants; Additionally, other synthetic drugs, as well as hallucinogens and the opium derivatives, were not popular among the Bahamian students.

 Lifetime prevalence for cocaine (1.2%) and ecstasy (1.0%) was even less than those for the prescription drugs.
Table 11: Prevalence of Other Drug Use by Gender Drug Cocaine Tranquilizers Stimulants Ecstasy Gender Females Males Total Females Males Total Females Males Total Females Males Total Lifetime 0.7 1.6 1.2 3.7 3.8 3.8 2.6 2.7 2.7 0.9 1.1 1.0 Prevalence Last 12 Months 0.4 0.9 0.7 2.6 2.0 2.3 1.9 1.6 1.8 Last 30 Days 0.1 0.5 0.3 1.7 0.8 1.3 1.5 0.9 1.2 3.7.
Average Age of First Use During the 11-year period between the 2002 and 2011 surveys, there were no major changes in the mean age of first use for those substances used most often by the teens (Table 12).

 The mean age of first use for the legal substances such as cigarettes (11.8 years) and alcohol (11.6 years) continues to be lower than the mean age of first 14 use for illicit substances such as marijuana (13.3 years); in this case by almost 2 years.
 The mean age of first alcohol use for females (11.9 years) was almost the same as that of their male counterparts (11.3 years).

 Males, on average, continued to experiment with marijuana and cigarettes at a slightly earlier age than females; in the case of cigarettes, approximately 1 full year earlier.
Table 12: Trend in Average Age of First Drug Use, By Type of Drug and Gender Marijuana Cigarettes Alcoholic Drink Gender 2002 2008 2011 2002 2008 2011 2002 2008 2011 Male 12.9 13.1 13.0 11.2 10.9 11.3 11.2 11.2 11.3 Female 14.0 13.6 13.7 11.7 11.9 12.4 11.9 11.5 11.9 Total 13.2 13.3 13.3 11.4 11.3 11.8 11.5 11.4 11.6 3.8.

Exposure to Various Substances and Other External Influences 3.8.1.
Exposure Through Parental Problems or Friends Who Drink Too Much or Use Illicit Drugs The proportion of students who indicated that they had at least one friend who they thought occasionally drank too much remained relatively stable between 2008 and 2011; from 60.7% in 2008 to 59.6% in 2011.
 A total of 9.1% had one friend; 38.4% - some friends; and 12.1% - a lot of friends; As compared to results from the 2008 (38.2%) survey, there was a slight increase in the proportion of students with a friend or friends who used illicit drugs.

 Approximately 4 of every 10 students (42.0%) was exposed to drugs through the presence of friends who used an illicit substance; o 6.4% - one friend; 27.5% - some friends; and 8.1% a lot of friends.
Students were also exposed to drug and alcohol use and its dangers at home through their parents drinking and/or drug use.

In this survey, they were specifically asked to indicate if either of their parents ever had problems due to drinking alcohol or drug abuse.

 15.5% of all students reported that they had at least one parent who had problems related to drinking alcohol.

15  Approximately 1 of every 20 (4.8%) students revealed that they had a parent with past problems related to drug use.

3.8.2.
3.8.2.

Ease of Access Overall, more of the students felt that it was easy to access marijuana than it was to access cocaine powder, ecstasy or crack (Figure 5).
 A total of 30.2% indicated that it would be “easy” to get marijuana; this compared to 10.8% for cocaine, 10.6% for crack and 9.2% for ecstasy; Figure 5: Figure 6: 16 Trend in the Proportion of Students Who Found it Easy to Access Selected Drugs37.915.616.59.730.210.810.69.201020304050MarijuanaCocaineCrackEcstasyPercent (%)20082011Proportion of Students Who Found it Easy to Access Selected Drugs by Grade Level17.410.17.511.333.410.28.51041.334.21210.401020304050MarijuanaCocaineEcstasyCrackPercent (%)Grade 8Grade 10Grade 12 Between 2008 and 2011, there was a decrease in the percentage of students finding access to drugs easy for all of the selected drugs (Figure 5).
 The percentage finding access to marijuana “easy” decreased from 37.9% in 2008 to 30.2% in 2011;  The percentage finding access to cocaine “easy” decreased from 15.0% in 2008 to 10.8% in 2011.

When these results were looked at by grade level, results revealed:  The proportion who felt that it was easy to access marijuana increased significantly as grade level increased (Figure 6).

o 17.4% - 8th grade; 33.4% - 10th grade; and 41.3% - 12th grade.
 The proportion of 12th graders who found it easy to access cocaine was three times that of the proportion in the 8th and 10th grades.

o 10.1% - 8th grade; 10.2% - 10th grade; and 34.2% - 12th grade.

3.8.3.

Exposure to Drug Prevention Programs To assess the extent of drug and alcohol prevention education in Bahamian secondary schools, the students were asked the following 4 key questions.
During this school year, were you taught in any of your classes:  The problems associated with drinking alcohol;  How to tell someone you did not want to drink alcohol;  The problems associated with using drugs like marijuana, cocaine or ecstasy;  How to tell someone you did not want to take drugs.
According to the students, during the current school year:  47.1% were taught about the problems associated with drinking alcohol;  34.4% were taught how to tell someone that you did not want to drink alcohol;  41.8% were taught about the problems associated with using drugs like marijuana, cocaine or ecstasy; and  36.8% were taught how to tell someone that you did not wish to take drugs.
As in previous years, drug prevention education programs were not universally implemented within schools and varied in its coverage across schools.

Unlike in previous years, however, it was the public schools, more so than the private schools, that was more likely to have introduced most of these topics to the students during the current school year (Table 13).

Additionally, in most cases, students in the higher grades were more likely to have received prevention education than those in the lower grades.
 Whereas 64.9% of the 8th graders had not been taught about the problems associated with drinking alcohol, this decreased to 60.7% and 40.6% for the 10th and 12th graders, respectively.

17  Similarly, 68.1% of the 8th grade students, as compared to 68.6% of 10th graders and 43.3% of 12th graders, had not been taught the problems associated with using drugs like marijuana, cocaine or ecstasy.
The exception seem to be in the private schools where the percentage taught how to tell someone that you did not wish to use either decreased as grade level increased or was inconsistent.
Table 13: Percentage of Students Participating in Drug Prevention Activities During Current School Year by Type of School and Grade Level Drug Prevention Activity Taught Private Schools The problems associated with drinking alcohol How to tell someone that you did not want to drink alcohol; The problems associated with using drugs like marijuana, cocaine or ecstasy; How to tell someone that you did not wish to take drugs.
Public Schools The problems associated with drinking alcohol How to tell someone that you did not want to drink alcohol; The problems associated with using drugs like marijuana, cocaine or ecstasy; How to tell someone that you did not wish to take drugs.

Grade 8 Grade 10 Grade 12 35.1 28.2 31.9 27.5 39.2 34.6 32.7 36.2 39.3 19.2 31.4 18.8 48.1 40.1 42.4 42.7 59.4 18.4 56.7 22.1 58.9 44.0 54.3 49.4 3.9.
Student Predisposition to Substance Use and Perception of the Risk of Taking Selected Substances The proportion of students who responded “maybe” or “yes” to the question “Whether you had ever been curious about trying drugs” remained relatively constant between 2002 and 2011.

 A total of 31.1% said “yes” or “maybe” in 2011, as compared to 32.1% in 2008 and 31.8% in 2002.
When asked the direct question “Would you try drugs if given the chance”,  A total of 14.9% said “maybe” and 6.6% “yes”; that they would try drugs.

The students were also asked to indicate the level of harm they associated with engaging in substance use at various frequencies.
Students rated these items on a scale of 1 to 5: 1 indicated the behavior was seen as not harmful; 2 that the behavior was slightly harmful; 3 indicated the behavior was moderately harmful; 4 that the 18 behavior was very harmful; and 5 indicated the students either didn't know the substance or how harmful that particular behavior was.

The results are displayed in Figure 7.


 The proportion of students who considered drinking alcohol “often” as “very harmful” decreased from 58.3% in 2002 to 51.5% in 2008 and 50.3% in 2011; This may partially account for the increase seen in alcohol consumption in all three prevalence indicators over this period.
 41.7% of all students felt that smoking marijuana sometimes was only moderately or less harmful: 8.2% not harmful; 12.1% slightly; and 21.4% moderately harmful;  The proportion who thought that smoking marijuana only occasionally was “very harmful” decreased from 51.6% in 2002 to 47.4% in 2008 and 45.6% in 2011;  28.3% of all students thought that smoking cigarettes sometimes was either not or only slightly harmful; a significant increase in the 7.2% that felt that way when persons smoked cigarettes frequently.
As indicated by the proportion who said “Don’t Know”, those drugs used less often by the students are also those less well known as regards their harmfulness.

 One of every 5 students said they “Don’t Know” how harmful is taking tranquilizers or stimulants sometimes (21.5%) or solvents or inhalants sometimes (20.5%);  23.2% indicated that they “Don’t Know” how harmful is taking Ecstasy sometimes.
In contrast, only 12.1%, reportedly, did not know how harmful smoking marijuana frequently was and 10% how harmful was the practice of getting drunk.
19 Figure 7: 20 Students' Opinion on the Harmfulness of Illegal Substances4.72.73.77.15.92.92.74.23.18.252.82.43.32.96.5423.64.56.614.19.66.23.913.65.212.164.126.33.117.5725.9121419.915168.523.114.121.410.815.85.214.88.12315.235.670.264.150.359.453.56438.657.945.66664.876.652.363.839.96010.210.611.68.61021.52120.519.612.712.112.513.823.222.213.113.80%20%40%60%80%100%Cigarettes SometimesCigarettes FrequentlyCigars FrequentlyAlcohol FrequentlyGetting DrunkTranquilizrs/Stimulants SometimesTranquilizrs/Stimulants FrequentlySolvents SometimesSolvents FrequentlyMarijuana SometimesMarijuana FrequentlyCocaine SometimesCocaine FrequentlyEcstasy SometimesEcstasy FrequentlySecondhand Smoke SometimesFrequentlySecondhand Smoke FrequentlySubstance/FrequencyNot HarmfulSlightly HarmfulModerately HarmfulVery HarmfulDon't Know 4.
Highlights of Behaviors Associated with Violence and Unintentional Injuries The students were also asked to report their experiences with violence and unintended injuries.

Violence, for purposes of this survey, occurred when a person or a group of people attack other people or a group of people with insults, bullying, hits, assault, robbery, or rape.

Results are displayed in Table 14.
Table 14: Selected Indicators of Violence and Unintentional Injury by Sex Indicators of Violence and Unintentional Injury Total % Sex Male % Female % Percentage of students physically attacked one or more times during the past 12 months Percentage of students in a physical fight one or more times during the past 12 months Percentage of students seriously injured during the past 12 months Percentage of seriously injured students hurt while playing or training for a sport during the past 12 months Percentage of seriously injured students hurt as the result of a fall during the past 12 months Percentage of seriously injured students whose most serious injury was a broken bone or dislocated joint Percentage of students bullied on one or more days in the past 30 days Among students who had been bullied on one or more of the 30 days, the percentage who were most often hit, kicked, pushed, shoved or locked indoors Percentage of students, who either hit, kicked or pushed other children everyday.
Percentage of students who missed school one or more days in the past 30 days because they felt unsafe at or on the way to school Percentage of students who belonged to a violent group Physical Attacks and Fights One of the sections relative to violence that was addressed by the students was the issue of physical attacks.
A physical attack, as defined in this survey, occurred when one or more people hit or strike someone, or when one or more people hurt another person with a weapon (such as a stick, knife, or gun).

It was not a physical attack when two students of about the same strength or power chose to fight each other.

In The Bahamas, 21.4% of secondary school students were physically attacked one or more times during the past 12 months.
 Male students (26%) were significantly more likely than female students (17.2%) to have been physically attacked during the past 12 months.

21 The students were also asked about fighting, which differed from attacks in that a physical fight occurred when two students of about the same strength or power chose to fight each other.

 Overall, 40.4% of the students had been in a physical fight one or more times in during the past 12 months.
 Male students (49%) were more likely than female students (32.2%) to have been in a physical fight.

4.2.

Serious Injuries The students were asked about any serious injuries that they may have sustained within the past 12 months.

An injury was considered to be serious if it made you miss at least one full day of usual activities (such as school, sports, or a job) or required treatment by a doctor or nurse.
 Overall, 30.1% of students said they had been seriously injured one or more times during the past year.

 Male students (34.2%) were more likely than female students (26.3%) to have been seriously injured.

Those students who were seriously injured during the past 12 months sustained their most serious injury in a number of different ways.
Results revealed that:  5.7% were in a motor vehicle accident or hit by a motor vehicle; 27.4% took a fall; and 13.6% were attacked or abused or was fighting with someone.

Regarding the nature of the injury, in 29.9% of the cases, the student’s most serious injury was a broken bone or dislocated joint.

As to the place or the event taking place when the injury occurred, 12.8% of those hurt during the past 12 months were hurt while playing or training for a sport.
 Male students (19%) were significantly more likely than their female counterparts (6%) to be playing or training for a sport when their most serious injury occurred.

4.3.

Bullying A subset of the questions on violence focused on the practice of and the students’ experience with bullying.

Bullying occurs when a student or group of students say or do bad and unpleasant things to another student.
It is also bullying when a student is teased a lot in an unpleasant way or when a student is left out of things on purpose.

It is not bullying when two students of about the same strength or power argue or fight or when teasing is done in a friendly and fun way.

Overall, 15.9% of students had been bullied on one or more days during the past 30 days.

There were no significant differences between males and females.
22 Among those bullied in the last 30 days, in 17.1% of the cases, the bullying most often involved being hit, kicked, pushed, shoved around or locked indoors.

 Male students (23%) were twice as likely as the female students (12.3%) to be bullied in this manner.

When the students were asked about their own aggressive behaviors in the past school year, results revealed that:  15.5% of the students admitted to either hitting, kicking or pushing other children on a daily basis.
 Females (15.5%) were equally as likely as males (15.4%) to exhibit such behavior.

In a related finding, 7.3% of the students reported they did not attend school on one or more days in the past 30 days due to their not feeling safe either at school or on the way to school.

There was no gender difference.

4.4.

Weapon Carrying and Other Safety Issues Most Bahamian students did not carry weapons during the month prior to the survey.
 Overall, only 18.2% of the secondary students carried a weapon such as a gun or knife on one or more days in the last 30 days.

 Male students (27.4%) were significantly more likely than female students (9.4%) to carry a weapon in the last 30 days.

As to the introduction of these weapons to the school community, a total of 10.4% of the students carried a weapon onto school property on one or more occasions in the last 30 days.
 Males (16.3%) were significantly more likely than females (4.8%) to carry a weapon onto school property.

As another act of violence, the students were asked the number of times, within the past 30 days, that someone had stolen or deliberately damaged their property while at school.

 Approximately 1 of every 4 students (24.9%) had their personal property damaged or stolen while on school grounds.

4.5.
4.5.

Abuse and Other Signs or Acts of Violence The survey also sought to determine if the students had ever been emotionally or verbally abused, physically abused or sexually abused.

 A total of 43.8% of all students had been emotionally or verbally abused in the past, while 21.2% had been physically abused and 9% sexually abused.

 Female students were significantly more likely than male students to have been emotionally, physically and sexually abused.
23 In response to the question of whether they had ever been forced to have sexual intercourse when they did not want to, 8.9% of all students indicated that they had.

 Females (11.7%) were significantly more likely than males (5.8%) to have been forced into sexual intercourse when they did not wish to.
As a result of the general perception by society that a large proportion of youth violence is due to gang involvement, specific questions were asked about the students’ own association with violent groups.

Results revealed that most Bahamian students do not belong to a violent group.

 Overall, only 11.3% of secondary school students, reportedly, belonged to such a group.
 The gender difference was significant with male students (15%) being twice as likely as female students (7.7%) to belong to a violent group.

24 5.

Students’ Mental Health and Other Risk and Protective Factors 5.1.

Mental Health Results regarding the students’ mental health are presented in Table 15.

As an indicator of the students’ mental health status, the students were asked how often they felt lonely during the past 12 months.
Based on the responses, 12.9% of secondary school students reportedly felt lonely “most of the time” or “always” during the past 12 months.

 Female students (16.3%) were significantly more likely than male students (9.4%) to feel lonely “most of the time” or “always”.

Closely related to the feeling of loneliness is the number of close friends that the students had.

Overall, 6.5% of the students reported having no close friends.
The students were also asked “During the past 12 months, how often have you been so worried about something that you could not sleep at night”.

Results revealed that, during this period, 14.8% of all students felt this way “most of the time” or “always”.

 Female students (19.4%) were significantly more likely than male students (9.7%) to “most of the time” or “always” feel so worried about something that they could not sleep at night.
Table 15: Selected Indicators of Students’ Mental Health by Sex Indicators of Mental Health Total % Percentage of students who felt lonely all or most of the time in the past 12 months Percentage of students who felt so worried all or most of the time in the past 12 months that they could not fall asleep Percentage of students who seriously considered attempting suicide during the past 12 months Percentage of students who made a plan about how they would attempt suicide during the past 12 months Percentage of students who attempted suicide on one or more occasions during the past 12 months Percentage of students who have no close friends 12.9 14.8 22.7 15.4 10.6 6.5 Sex Male % Female % 9.4 9.7 15.8 10.8 6.9 8.5 16.3 19.4 29.2 19.5 13.9 4.6 As another indicator of the psychological state of the students, the students were asked about thoughts of suicide and whether this had lead to any attempts at taking their own life.
Results revealed that:  Overall, 22.7% of secondary school students seriously considered attempting suicide during the past 12 months.

 Female students (29.2%) were significantly more likely than male students (15.8%) to seriously consider attempting suicide.
25 Going beyond just seriously considering suicide, the data also showed that during the past 12 months:  A total of 15.4% of the students, reportedly, made an actual plan about how they would attempt suicide; and  10.6% had in fact attempted to commit suicide, at least once; 6.9% of the males and 13.9% of the females.

5.2.
5.2.

Risk and Protective factors Some of the questions relative to those factors known to be associated with behaviors that could lead to or mitigate against substance use, acts of violence or unintentional injuries touched on spirituality, treatment by peers, signs of problems, risk-taking behaviors and relations with parents or guardians.

Selected results are presented in Table 16.

In the Bahamas, 65.0% of all secondary school students thought of themselves as a religious or spiritual person.
 Slightly more females (68.6%) than males (61.6%) were likely to think of themselves as spiritual or religious.

Overall, 35.4% of the students reported that most of the students in their school were “never or rarely” kind or helpful.

There was no significant difference between males and females with regards to this opinion.
Table 16: Selected Risk and Protective Factors by Sex Risk and Protective Factors Percentage of students who missed classes or school on one or more days during the past 30 days Percentage of students who reported that most of the students in their school were never or rarely kind and helpful Percentage of students whose parents or guardians never or rarely checked to see if their homework was done during the past 30 days Percentage of students who parents or guardians never or rarely understood their problems or worries during the past 30 days Among students who rode in a motor vehicle driven by someone else, the percentage who never used a seat belt during the past 30 days Percentage of students who think of themselves as a religious or spiritual person Total % Sex Male % Female % 21.2 24.5 18.0 35.4 35.5 35.1 41.1 38.4 43.4 47.0 44.0 49.5 17.0 20.3 13.8 65.0 61.6 68.6 When asked the number of days during the past 30 days that they had missed classes or school without permission, 21.2% of all students admitted that they had missed classes or school on one or more days.
26  Male students (24.5%) were more likely than female students (18%) to have missed a class or school day during this period (Table 16).

The students were also asked questions related to the status of their connection with their parents or guardians during the last 30 days.
 41.1% reported that their parents/guardians never or rarely checked to see if their homework was completed;  47.0% said that their parents/guardians never or rarely understood their problems or worries;  39.5% were of the opinion that their parents/guardians never or rarely respected their sense of freedom;  30.6% of all students said that their parents/guardians never or rarely listen to them;  46.0% of students reported that their parents/guardians never or rarely praise them; and  25.1% of the students indicated that their parents/guardians never or rarely spent time with them.
27 6.

Conclusions and Recommendations The survey shows that problem use of alcohol and drugs and engaging in acts that could lead to violence and unintentional injuries are not rare among youth.

Potentially harmful consequences such as smoking marijuana, binge drinking and becoming drunk, fighting, weapon carrying and bullying are not uncommon occurrences.
Combined with the fact that many of our teens are exposed to less than ideal family settings, which all contribute to a relatively high level of mental or psychological challenges, there is an urgent need for programs to focus on reducing these harmful consequences.

Prevention efforts should include a component that targets young persons’ beliefs and attitudes about drugs, specifically the risks of physical harms that can occur from use.
The perceived risk of harm of using a substance is associated with concurrent and subsequent decreases in the rate of use, and vise versa.

As these attitudes and attitude-behavior relationships are drug-specific, any prevention effort should provide drug-specific information.

Finally, the program recommendations put forth in this document are not intended to serve as a detailed plan but only to direct program planners and managers to those areas in need of intervention.
These should be followed up with comprehensive action plans, supported by annual budgets, whose implementation should be closely monitored and evaluated.

A number of the recommendations suggested based on the results of this survey have been repeated from other similar surveys conducted in the past; i.e., the 1997 Adolescent Health Survey3 and the 2003 and the 2008 Secondary School Drug Prevalence Surveys.
In general, the recommendations reflect:  Policies that should be agreed upon as the guiding principles for shaping the response to the key issues;  Programs and/or projects that should be implemented; and  The research that is necessary to periodically assess violence, drug and other behavior-related trends in the adolescent population and to monitor and evaluate subsequent interventions.

6.1.
6.1.

Policy Recommendations As there was also an association between use and availability, efforts must be taken to control access to the legal substances such as alcohol and cigarettes through stricter government policies.
 Classify the prevention of psychotropic substance use and abuse as a priority in every community;  Policies and laws that will halt illegal activities and the sale of alcohol to minors be strengthened and enforced;  Ensure that every adolescent with a substance abuse problem can receive treatment via a school-based program or a good referral system; 3 Health Information and Research Unit, Ministry of Health.

Bahamas Adolescent Health Survey, 1997.
28  Strengthen anti-drug cooperation efforts, in particular at the technical level, between relevant government departments and ministries, non-government organizations and international agencies in order to maximize opportunities for assistance and support and to better position stakeholders to develop more comprehensive policies and implement more effective programs;  Improve evidence-based decision-making through the development of a culture of program and project monitoring and evaluation and an improvement in the information system on drugs and drug use in the schools; o Such surveillance should capture records of drug-related incidences and resolutions, anti-drug program participation, etc.
6.2.

Programmatic Recommendations 6.2.1.
Drugs Due to the fact that so many of the students have already been exposed to alcohol and had drank within the past year, with approximately one-half of them engaged in binge drinking, to the fact that the current laws have had limited success in limiting access to alcohol, that marijuana smoking is so popular, especially among males and the older age groups, and because of the relatively easy access to illicit substances by the adolescents, and their willingness to engage in risky behaviors, it is recommended that steps be taken to:  Implement or strengthen substance abuse prevention programs in the schools, beginning in the primary schools, with reinforcements continuing throughout the students’ school careers and ensuring that programs are age appropriate and address all drugs; o Sessions should incorporate, along with others, messages on the dangers of binge drinking, particularly alcohol poisoning, the link between health, behavioral and other problems and drug or alcohol use, and strengthening the students’ decision-making skills.
 Strengthen substance abuse prevention in the community by targeting young persons after school, dropouts, parents and high-risk families; o Parents should be educated about access to alcohol within the homes; excessive drinking by adults within the home and its impact on teens; the influence of friends on the teens’ own drug and alcohol use; the gateway phenomenon; etc;  Increase mass media coverage of substance abuse and prevention issues and develop more targeted messages designed to encourage protective factors while discouraging risk factors.
6.2.2.

Violence As a result of the high numbers of teens who have been attacked, involved in fights, engaged in or were the victims of bullying, were members of violent groups and had 29 access to dangerous weapons which they often carried with them, it is recommended that:  Programs be strengthened or established for teens that address decision making, the fact that actions have consequences, goal setting, conflict resolution, etc.
;  Programs be established for parents that stress the need for and appropriate methods of discipline, positive and negative reinforcement; etc.

;  These lessons be strengthened with the establishment or further addition of organizations for teens that cater to their expressed desires or needs, and that will keep them involved;  A qualitative survey be conducted to determine the reasons for weapon carrying both in and out of school; 6.2.3.
Mental and Emotional Concerns Due to the unacceptable levels of emotional, physical and sexual abuse, the number of adolescents whose general demeanor was not healthy, and because of the association with acting out in manners that are self-destructive like substance abuse, thoughts of and attempted suicides and other violent acts, it is recommended that:  A system is established that will facilitate the recognition of troubled kids, such as those with problems at home, in school, those showing signs of abuse, etc.
;  Appropriate treatment for such teens be made available, either within the school system or in other institutions that will not stigmatize the teens;  Sessions be held for parents, either in the schools or at their homes, which could serve to teach them how to be of more assistance to their children.

6.3.

Future Research Recommendations Substance use by young people is an ever-changing phenomenon that requires ongoing monitoring and evaluation.
As new drugs come on the scene, it is important to assess their use and perceptions about them.

Monitoring health risk behaviors, such as substance use, behaviors that may lead to violence, or other risky behaviors that may result in unintentional injuries, over a period of time provides valuable information about determinants, changes and co-occurrences of the behaviors.
This enables key stakeholders to evaluate the effects of policies (e.g., smoking bans on school property, anti-bullying programs), education programs, and whether health objectives are achieved.

Although it is premature to know or even guess what the near future holds for adolescent drug use and anti-social behaviors, we can closely monitor any changes to ensure that any programmatic responses are based not on sensationalized fears, but rather on sound scientific information.
Consequently, it is recommended that:  Similar cross-sectional prevalence surveys are conducted every 2-3 years; 30  Quantitative survey information is supplemented with that from qualitative assessments such as focus groups and panel surveys that target all stakeholders (students, teachers, parents, administrators, etc).

31