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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA. “A STUDY TO EVALUATE THE EFFECTIVENESS OF INFORMATIONAL BOOKLET REGARDING KNOWLEDGE ON EFFECTS OF PSYCHOACTIVE SUBSTANCE USE AMONG ADOLESCENTS IN SELECTED HIGH SCHOOLS AT KOLAR”. PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION. Mrs. KAVITHA B.G. AE & CS PAVAN COLLEGE OF NURSING KOLAR, KARNATAKA. 1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. NAME OF THE CANDIDATE Mrs. KAVITHA .B.G 2. NAME AND ADDRESS OF THE A.E. & C.S. PAVAN COLLEGE OF INSTITUTION NURSING COURSE OF STUDY AND M.Sc NURSING I YEAR PEDIATRIC SUBJECT NURSING 3. 4. DATE OF ADMISSION TO THE 07/06/2011 COURSE “A STUDY TO EVALUATE THE EFFECTIVENESS OF INFORMATIONAL BOOKLET REGARDING KNOWLEDGE 5. TITLE OF THE TOPIC ON EFFECTS OF PSYCHOACTIVE SUBSTANCE USE AMONG ADOLESCENTS IN SELECTED HIGH SCHOOLS AT KOLAR” 2 6. BRIEF RESUME TO INTENDED WORK INTRODUCTION:“Habit, if not resisted soon becomes necessity”. Saint Augustine. The term Health and wellness are used interchangeable. Health is of ten described as absence of illness where as wellness is often given a more positive connotation, suggesting that it involves more than absence of illness. The term illness refers to deviation from the normal health. A large number of life changes may cause illness.1 Health is an essential factor for a happy contended life. If children are healthy then future generation will be healthy resulting in healthy nation. Today’s children are tomorrow is citizens.2 In most societies, use of substances to alter mood, behavior, perceptions, etc is accepted in our culture, use of caffeine, and nicotine is widely accepted as normal. Nevertheless, as you are probably aware, these substances especially can lead to all sorts of problems for the user. And there are many other substances that people take which have even clearer risks associated with them, cocaine, heroin, barbiturates etc. Psychoactive substances are the chemicals which affect the central nervous system, there by altering mental functioning. Most people have had some experience with their drugs, the substances become a problem when their consumption becomes habitual, when a craving develops, leading to and / or exacerbating persistent social, occupational, psychological and physical problems.3 Psychoactive substance use is one of the major public health problems in the USA. Alcohols affect millions of people; it is the most common substance use disorder. Deaths associated with alcohol use ranks third, behind heart disease and cancer. Substance use disorder knows no social class boundaries, people at all levels of society may fall victim Understanding and dealing with substance use is very difficult and complex. Recreational drug use is so widespread. 3 Complex interactions of physical, chemical psychological, socio-cultural variables are involved in drug use. Certain drugs (alcohol, tobacco) although culturally accepted, pose resinous dangers to users. While other drugs may be illegal and culturally unaccepted. Yet pose less of a hazard.3 Psychoactive substance use has become a matter of global concern because of the impact on individual healthy, familial and social consequences. Psychoactive substance use is found in all age groups. Its prevalence is highest among young adolescents and young adults, a large majority of whom are students.4 The use of psychoactive drugs can be categorized into 5 basic patterns - For many persons, they never progress to later patterns of abuse. However, as dependency increases, so does the possibility for compulsive, dysfunctional drug use.3 1. Experimental use: Short - term use, motivated by curiosity, social, social contexts. 2. Social recreational use: friends and acquaintances wanting to share a pleasurable experience. 3. Circumstantial situational use:- motivated by the desire to achieve a known drug effect in order to cope with a specific situation or event. 4. Intensified use: long term use (often once a day) motivated by a desire to obtain relief from problems and stress. 5. Compulsive use: frequent and intense use producing some degree of psychological dependence and possible physical dependence.3 As use becomes increasingly compulsive, social, psychological and physical impairments become more pronounced eventually, if the abuse goes unchecked, numerous and profound dysfunctions develop.3 There are numerous psychoactive substances. These include. Alcohol. Nicotine. Amphetamines. cannabis 4 cocaine Hallucinogens. Opioids. Sedatives and hypnotics. The use of these substances is not limited to back- street, dark alleyways many of these substances use found in easily available, every- day products and /or may have proven medicinal value for example. Amphetamines - diet pills Opioids - analgesics, cough suppressants, anesthetics Sedatives - Sleeping pills.3 5 6. NEED FOR THE STUDY. Psychoactive substance use is a practice that dates to prehistoric times. According to world Health organization health is defined as “Health is a state of complete physical, mental and social wellbeing and not merely absence of disease or infirmity”. Psychoactive substance is a chemical substance that crosses the blood brain barriers and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition and behavior. these substances may be used recreationally, to purposefully alter one’s Consciousness, entheogens for ritual, spiritual, and / or shamanic purposes as a tool for studying or augmenting the mind, or therapeutically as medication Because psychoactive substances bring about subjective changes in consciousness and mood that the uses may find pleasant or advantageous. Many psychoactive substances are abused that is used excessively, despite the health risks or negative consequences.5 Psychoactive substance use has become a matter of global concern because of the impact on individual healthy, familial and social consequences.4 Psychoactive substance use is found in all age groups. Its prevalence, is highest among young adolescents and young adults a large majority of whom are students.4 Hence drug education is an important tool in preventing psychoactive substance use. Students in college being an education group, psychoactive substances use awareness and education will help to increase their knowledge and develop a favorable thought towards prevention of psychoactive substance use. 4 There is archaeological evidence of the use of psychoactive substances dating back to at least 10000 Years. And historical evidence of cultural use over the part 5000 years.4 6 The psychoactive substance use posses a significant threat to the health social and economic fabric of families. Communities and nations.4 Today there are about 190 million drug users around the world. Drug use has been increasing among the young people worldwide. Most drug abusers are under the age of 306. Cannabis is the most widely abused drug in all parts of the world. The extent of worldwide psychoactive substance use is estimated at 2 billion alcohol users. 1.3 billion Smokers and 185 million drug users.6 The number of people admitted to the drug de- addiction centers in Chandigarh and Bhatinda clearly shows the magnitude of the problem. For ten months the number of total addicts registered was 5,225 of whom poppy husk addicts were 2447 and opium 1051.7 The incidence of drug abuse among children and adolescents is higher than the general population. This is notably because youth is a time for experimentation and identity forming. In developed countries drug abuse among youth is generally associated with particular youth subcultures and lifestyles. In Asia figures of drug abuse are hard to find but after cannabis, Amphetamine type stimulants are the most commonly uses amongst children and youth. There have been various studies carried out in the region regarding drug abuse.8 A 1996 study of eight cities in seven provinces of china showed that over a half of heroin abusers are below 25 years of age. A School survey conducted in 1999 among students aged 12 to 21 years, in Vientiane, reported 4.8 percent lifetime abuse for amphetamine type stimulants.8 In India an Ngo survey revealed that 63.6% patients coming in for treatment were introduced to drugs at a young age below 15 years. According to another report 13.1% of the people involved in drug and substance abuse in India, are below 20 Years. Heroin, opium, Alcohol, Cannabis and propoxyphene are the five most common drugs being abused by children in India. A survey shows that of 7 all alcohol, cannabis and opium users 21%. 3% and 0.1% are below the age of eighteen. An emerging trend about child drug abusers is the use of a cocktail of drugs through injection and often sharing the same needle, which increases their risk of HIV infection Overall 0.4% and 4.6% of total treatment seekers in various states were children.8 The use of tobacco is another major concern amongst children. In India 20 million children a year and nearly 55,000 children a day are drawn into a tobacco addition. The number is shocking when compared to the 3000 a day new child smokers in the Us.8 A national household survey was carried out in India for estimating the extent of substance dependence for alcohol and opiates. The data was collected between March 2000 & November 2001. In this study, the current prevalence of alcohol was 21.4%, cannabis 3.0%, heroin 0.2%, opium 00.4% and other opiates 0.1%. Another important finding of this survey was that in the range of 17-29% of current users of various substances was dependent users.9 A study was conducted by national institute of policies on alcohol and Drugs National Council of Technological and scientific Development to estimate the association between early life exposure to violence, alcohol disorders and illegal substance use in adulthood and the role of depression on these associations using a national Brazilian sample. First they gathered information on early exposure to violence and use of psychoactive substances in 1880, participants aged 20 to 60 years old were selected at random from the Brazilian household population. And used weighted logistic regression to calculate adjusted odds ratios for the associations between early exposure to violence and substance misuse. And assessed the mediating effect of depression on these associations by the SobleGoodman mediation test. The results witnessed violence during childhood or adolescence nearly 20% of the participants whilst over 8% having been victims of at least one form of violence, and there was statistically significant association between early exposure to violence and alcohol abuse and/or dependence and use of illegal substances in adulthood. With a dose response relationship and depression partially explained the association between early exposure to violence 8 with alcohol dependence (18.77% P<0.001) and did not have a statistically significant mediating effect on the association with illegal substance use (5.83% P= 0.220) and the prevalence of substance misuse in adulthood may be in part attributed to the prevalence of adverse childhood may be in part attributed to the prevalence of adverse childhood experience.10 A cross-sectional study was conducted in Sao Jose do Rio Preto, Sao Paulo state, Southeast Brazil to investigate the prevalence of drug consumption among secondary school students and a self applied questionnaire was answered by proportional sample of 1,041 teenagers enrolled in 9th, 10th and 11th grades in public schools. This study suggested the prevalence of psychoactive substance use in Sao José do Rio Preto at rates similar to those found in other Brazilian studies.11 Based on the research studies the psychoactive substance use is more a symptom than the cause of problems in today’s society among adolescents. Hence the investigator felt that adolescents should have awareness regarding knowledge on effects of psychoactive substance use through informational booklet. 9 6.2 REVIEW OF RELATED LITERATURE. The review of literature is defined as a broad Comprehensive in depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, audiovisual materials and personal communication. Critical review of literature refers to the process in which the investigator or reader examines the strength and weakness of the appropriate scholarly publications / literature. The term “Scholarly Literature” Can refer to published and unpublished data - based literature and conceptual Literature materials found in print and non print from “Data - based resources” are reports of completed research. “Conceptual literature” can be reports of theories, some of which underlie reported research as well as non-research material.12 Section A :- Studies seated to effects of psychoactive substance use. Section B :- Studies related to prevalence of psychoactive substance use among adolescents. Section C :- Studies related to interventions of psychoactive substance use. SECTION A : STUDIES RELATED TO HEALTH EFFECTS OF PSYCHOACTIVE SUBSTANCE USE. A Study was conducted to investigate mental health problems and emotion regulation abilities in adolescents and young adults with cannabis dependence. And explored the relationships between consumption modalities and affective style. There fore 32 cannabis abusers (CA) and 30 healthy controls completed a battery of self - reports measuring depression (BD1-13). anxiety (STA1-Y), alexithymia (TAS20; BVAQ-B) anhedonia (PAS; SAS) and sensation seeking) sss) the MINI was administered to evaluate Cannabis dependence and axis 1 DSM - N Como bid diagnoses. (S semi - structured clinical interview was given to determine psychoactive substance use. This study demonstrate that cannabis dependence in adolescents and young adults is related to a great psychological distress and specific emotional dimensions and puts emphasis on the importance of substance use prevention as early as middle school.13 10 A study was conducted by blind raters with structured diagnostic interviews and examined the risks in first - degree relative for attention deficit hyperactivity disorder, psychoactive substance usedisordes, alcohol dependence, and drug dependence fro, a large group of paediatric ally and psychiatrically referred boys with (112 probands, 385 relatives and without (105 probands, 385 relatives) attention deficit hyperactivity disorders. This study suggested that the association between attention deficit hyperactivity disorder and drug dependence is most consistent with the hypothesis of variable expressivity of a common. Risk between these disorders, whereas the association between attention deficit hyperactivity disorder and alcohol dependence is most consistent with the hypothesis of independent transmission of their disorders and also suggest specificity for the transmission of alcohol and drug dependence.14 A prospective observational case control study was conducted in the Tilburg region of the Netherlands from May 2000 to august 200 to estimate the association between psychoactive drug use and motor vehicle accidents requiring hospitalization. Cases were car or van drivers involved in road crashes needing hospitalization. Demographic and trauma related data was collected from hospital and ambulance records sampling was conducted by researches and respondents were interviewed and asked for a urine and blood sample. The study concludes that drug use, especially alcohol, benzodiazepines and multiple drug use and drug alcohol combinations, among vehicle drives increases the risk for a road trauma accident requiring hospitalization.15 A prospective cohort study of 804 adolescents aged 11-17 years, and their parents who were followed for seven consecutive years was conducted to examine the association between parental affective disorders and psychoactive substance use disorders and the onset of major depressive disorder among adolescents and young adults and to determine whether this association is affected by stressful life events family cohesion. Self - esteem or gender, the sample was drawn from the Minneapolis - st Paul metropolitan area parental diagnoses were based on structured clinical interview for administered during study screening stage. Diagnoses of major depressive disorder and age of onset were based on composite International Diagnostic Interview 2.1 administered during final year of data 11 collection. This study resulted that only parental affective disorders, low self esteem and gender were significantly related to the onset of major depressive disorders. Females were twice as likely as males to experience major depressive disorder.16 A comprehensive review of the English - language literature study of preadolescents (<12 yrs) who subsequently developed psychoactive substance use disorders or were offspring of parents with psychoactive substance use disorders was undertaken. In all nine longitudinal studies and 13 cross - sectional studies were identified. The results conclude that near psychiatrically impaired children of parents with psychoactive substance use disorders may represent those at highest risk for later development of psychoactive substance use disorsers.17 SECTION B : STUDIES RELATED TO PREVALENCE OF PSYCHOACTIVE SUBSTANCE USE AMONG ADOLESCENTS. A two cross - sectional studies were carried out for the instrument test rest with sample comprised male and female students aged 19 years from public and private schools in the city of Salvador, Northeast- tern Brazil, in 2006. A total of 591 questionnaires were applied in the test and 467in the retest the prevalence of substance use / misuse was similar in both test and retest.18 A comparative study of use of psychoactive substances amongst secondary school students in two local Government Areas of AKwa ibom state Nigeria was conducted during the second term of 2004/2005 school session, using a youth survey questionnaire. A total of 254 students, consisting of 119 from Uyo and 135 from Eket were analyzed. More students from Uyo, used kola nuts, 54 sedatives while more students from Eket, 47 used tobacco / cigarettes, 76 alcohols, 21 Indian hemp 5 cocaine and 1 heroin. The findings of this study confirm the presence and use of psychoactive substances in varying proportions among students.19 A epidemiological study was conducted to analyze 3446 sets of questionnaires among 12, 15 and 19 years old students on psychoactive substance use. And the questionnaires revealed statistically significant coincidence of 12 depression and use of alcohol and narcotics in girls and busy in all age groups and of depression and smoking in 12 years old boys. The findings allow for indication of depressive children and adolescents as a risk group of substance abuse and dependency development.20 A Study was conducted to know one year prevalence rates for psychoactive substance use by community surveys in three sites in china Hunan, Heilongjiang and Jiangsu. With 14000 respondents (15-65 years old) the drinking rates were from 58.3 to 82.6% for men and from 0.1 to 20.5% for women. Most drinkers were light users and most smokers were heavy users. Illicit drug use was observed at Hunan, regarding frequency and quantify of psychoactive substance use, women are lighter consumers than their male counterparts except for use of minor tranquilizers and analgesics. The psychosocial factors seated to drinking and smoking were also investigated in this study.21 A study was conducted using a ‘snowballing’ technique to collect prospective data from 135 regular drug using individuals in two Scottish towns, Edinburgh, and Ayr data from the first wave suggested that poly drug use is common with a major reliance on licit, prescribed substances. Amongst intravenous and non - intravenous drug users, awareness and concern about HIV/ AIDS did not appear to produce significant changes in sexual behavior. Furthermore responses from intravenous users indicated that there is no large scale adoption of safer injection technigqes.22 A study was conducted to relate current use by 11th grade students of 17 psychoactive substance and intoxication to characteristics of high schools in which they are enrolled. The 2,471 11th grade students surveyed were enrolled in a representative sample of 44 California high schools correlations between schools based on twelve characteristics were analyzed by means of a complete linkage Chester analysis.23 13 SECTION C : STUDIES RELATED TO INTERVENTIONS OF PSYCHOACTIVE SUBSTANCE USE. A study was conducted to assess the efficacy of a brief motivational enchantment intervention in adolescents referred to psychiatric treatment who reposted subsdomly allocated tone of two groups. 59 subjects entered the experimental group and 44 the control group. Structured questionnaires assessing knowledge, problems, perception of risks and intention of use of psychoactive substances were administered upon admission and 1 month later. The findings of this study results that brief intervention in adolescents entering psychiatric treatment led to a significant change in overall knowledge about psychoactive substances but not in other variables related to use.24 A study was conducted to evaluate the effectiveness of a brief intervention and a preventive. Orientation on the use of alcohol and other drugs dissected towards adolescents in a primary health care unit. Ninety nine samples were randomly classified. According to their level of consumption of substances, into users during the last month or non users during the last month and each of there was divided into four groups ,a control group of users in the last month, a control group of non users in the last month, a brief intervention group and a preventive orientation group. A structured schedule were followed and evaluated for a 6 months period. The results confirm that a single brief intervention session is effective in reducing consumption of psychoactive substances in adolescents.25 A study was conducted among homeless adolescents who used alcohol or illicit substance but were not seeking treatment were recorded during brief motivational intervention. Sample of 54 were randomly coded during sessions for adolescent language on the basis of motivational interviewing concepts, and ratings were tested as predictors of rates of substance use over time. The results indicate that statements about desire or ability against change, although infrequent, were strongly and negatively predictive of changes in substance use rates at both 1- and 3 month post baseline assessment statements about reasons for change were associated with greater reductions in days of substance use at 1- month assessment Commitment language was not associated with outcomes. Results suggest that specific aspects of adolescent speech in brief interventions may be important in the prediction of change in substance use.26 14 A study was conducted to compare substance involvement among psychiatrically hospitalized adolescent smokers who had revived motivational interviewing verses brief advice for smoking coruscation191 adolescent smokers were sand only assigned to motivational interviewing the results of this study suggest that motivational interviewing relative to brief advice for smoking cessation was associated with better substance use outcomes 3eduring the first 6 months following psychiatric hospitalization among adolescents.27 A study was conducted to evaluate the longitudinal association between frequency of substance use and quality of life among adolescent receiving a brief outpatient intervention. Participants were 106 adolescents, aged 13 to 21 years, who met criteria for substance abuse or dependence and completed 4 assessments over a 12 month period and a parallel process latent growth curve model was used and the results of this model indicated a moderate longitudinal association such that reduced frequency of use was associated with quality of life improvement Elaboration of the temporal ordering of this association via a cross - lagged panel model revealed that frequency of substance use predicted subsequent quality of life, but that quality of life did not predict subsequent frequency of use.28 A study was conducted to evaluate the efficacy of a brief motivational enhancement therapy in reducing cannabis use and cannabis - related problems in a population on non-treatment - seeking adolescent cannabis users 40 young people (aged 14-19 years) were randomly assigned to either a two session brief intervention or a 3-month delayed treatment control condition in a randomized controlled trial. The intervention consisted of a detailed assessment and a session of motivational enhancement therapy. An additional optional discursion of skills for reducing or quitting cannabis use was offered. The primary outcome measures were changes in days of cannabis use, mean quantity of cannabis used weekly and number of Diagnostic and statistical manual of mental Disorders, Fourth Edition dependence symptoms reported The approach. is acceptable to participants and merits further evaluation with this difficult to reach population.29 A pilot study was conducted to demonstration that it is feasible of administer brief individualized interventions on alternative high school campuses to students who are at risk of substance abuse students actively participated in brief motivational interviews and showed some improvement in five - of nine out comes at three- month follow -ups.30 15 STATEMNT OF PROBLEM A Study to evaluate the effectiveness of Informational booklet on Knowledge of effect of Psychoactive Substance Use among adolescents in selected High Schools at Kolar. 6.3 OBJECTIVES : 6.3.1 To assess the existing level of Knowledge regarding effects of psychoactive substance use among adolescents. 6.3.2 To determine the effectiveness of Informational booklet regarding Knowledge of effects of psychoactive substance use among adolescent. 6.3.3 To find the association between of Knowledge on effects of Psychoactive substance use with their selected variables . 6.4. OPERATIONAL DEFINITIONS : Evaluate : It refers to measuring level of Knowledge regarding effects of Psychoactive Substance use among adolescent in selected high schools Kolar. Effectiveness : Refers to the extent to which the Informational Booklet on Knowledge of effects of Psychoactive substance use has desired effect in improving the knowledge of adolescent. Informational Booklet : it is a well organized learning material prepared by investigator for the selected adolescents to enhance the knowledge on effects of Psychoactive substance use. Knowledge : The ability of Clients to answer the questions regarding effect of Psychoactive substance use. Psychoactive Substance use: It is as chemical substance that crosses the blood brain barrier and acts primarily upon the central nervous system. Where it affects brain function, resulting in changes in Perception, mood, Consciousness, cognition and behavior. Adolescents: Students between the age group of 13-18 year. 16 6.5 HYPOTHESIS OF THE STUDY : H1 : There will be significant difference between level of Knowledge scores of adolescents regarding the effects of Psychoactive substance use. H2 : There will be significant association between level of knowledge scores of adolescents regarding the effects of psychoactive substance are with their selected variables. 6.6 ASSUMPTIONS Informational Booklet regarding effects of psychoactive substance use may give awareness. 6.7 VARIABLES UNDER THE STUDY: Independent Variable Informational booklet regarding Knowledge on effects of psychoactive substance use. Dependent variable Knowledge of adolescents on effects psychoactive substance use. Attributed Variables Age, Sex, Educational status, Occupational Status, Family income, Type of family, Religion. 6.8 DELIMITATION: Children between the age group of 13-18 years in selected school at Kolar. Students who are willing to Participate. Students who are regular to the class. Students who are studying in English Medium School. 17 7. MATERIALS AND METHODS: 7.1 Source of Data : Adolescents of selected high schools at Kolar. 7.2 Method of Data collection: Prepared questionnaire and information booklet will be used to assess the knowledge regarding psychoactive substance are among adolescents. 7.2.1 Research Approach: Evaluatory approach. 7.2.2 Research Design : A descriptive design 7.2.3 Setting at the study: Study will be conducted in selected Gokula High School at Kolar. 7.2.4 Population: The population of present study comprises all adolescents. 7.2.5 Sample: The sample of present study comprises adolescents of age group 13-18 years. 7.2.6 Sample Size: The sample size of the present study will be 100. 7.2.7 Sampling Technique Total enumerating sampling technique will be used to select sample 7.2.8 Sampling criteria: Inclusion Criteria 1. Students who are in age group 13-18 Years 2. Students who are present. 3. Students those who are interested. Exclusion Criteria: 1. Students those who are absent. 2. Students those who are not interested. 7.2.9 Tool for data Collection: 1. Tool Consents of Section A and section A Section B Section A : Items on demographic variables like age, educational qualification, Occupation, Family income, type of family, religion availability of mass media in area. 18 Section B: Prepared questionnaire and information booklet on psychoactive substance are in terms of knowledge among adolescents. 7.3 DATA ANALYSIS AND INTERPRETATION: The data will be analyzed by using descriptive and inferential statistics such as frequency, mean, mean, percentage, standard deviation, Paired‘t’ test, chi square (x 2) test between knowledge score with selected demographic variables. 7.4 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE CONDUCTED ON OTHER HUMANS? Yes Study requires intervention Information Booklet on knowledge of psychoactive substance use, adolescent to be conducted on other humans. 7.5 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? Yes, prior to the study, Permission well be obtained from the concerned authorities and research committee of Pavan college of Nursing Kolar to conduct the study. 19 8. REFRENCES 1. Grace Akella, Rai Ries Primary school Children’s Perspectives on common diseases and medicines used journal of health 2007 June 7(2) : 65 2. Ann. Ashworth Alan Jackson, Focusing on malnutrition management to improve child survival in India Journal of Indian Academy of pediatrics 2007 June , 44(6) ;413 3. www.google.com cc village. buffalo.edu /Abpsy/lecture 20. html 4. NIGHTINGALE Nursing Times A window for health in action Vol7 No October 2011 page No 24 5. www.google.com coactive drug from Wikipedia the free encyclopedia 6. 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Hao W Young D, LiL, Xiao S” Psychoactive substance use in three sites in china gender differences and related factors” 1998 Dec ; 52 Suppl: S 324-8. www.pubmed.com 22. Morrison V. “Psychoactive substance use and related behaviors of 135 regular illicit drug users in Scotland” 1998 April ; 23(2) : 95-101. www.pubmed.com 23. Skager R Fisher DG “Substance use among High school students in relation to school characteristics” 1989; 14(2) : 129-38. www.pubmed.com 24. Goti J Diaz R, Serrano L, Gonzalez L, Calve R, Gual A, Castro J “Brief intervention in substance use among adolescent psychiatric Patients a randomized controlled trial” 20 June ; 19(16) : 503-11. Epub 2009 Sep 25. www.pubmed.com 25. Micheli D, Fishery M Formigoni ML, Study on the effectiveness of brief intervention for alcohol and other drug use directed to adolescents in primary 21 health care unit. 2004 July-Sep; 50(3) : 305-13. Epub 2004 Oct 21. www.pubmed.com 26. Baer JS, Bead Nell B, Garrett SB, Brazier B, wells EA, Peterson PL , “Adolescent change language within a brief motivational intervention and substance use out comes” 2008 Dec ; 22(4) : 570-5. www.pubmed.com 27. Brown RA Strong DR, Abates AM, Myers MG, Ramsey SE, Kahler CW “Effects on substance use out comes in adolescents receiving motivational interviewing for smoking cessation during psychiatric hospitalization” 2009 Oct ; 34(10) : 887-91. Epub 2009 March 11. www.pubmed.com 28. Becker Sl, Curry JF, Yang C , “Longitudinal association between frequency of substance use and quality of life among adolescent receiving a brief outpatient intervention” 2009 Sep ; 23(3) : 482-90. www.pubmed.com 29. Martin G. lope land “The adolescent cannabis check up randomized trial of brief intervention for young cannabis users” 2008 June ; 34(4) : 407-14. Epub 2007 Sep 14. www.pubmed.com 30. 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