Knowledge, attitudes and behaviours on tobacco, alcohol and drugs among Nigerian secondary school students: differences by geopolitical zones

Background: Nigeria includes six geopolitical zones and one Federal Capital Territory (FCT). The zones differ from each other in many characteristics including health indicators of adult and child population. Substance use among adolescents is a public health concern. However, the available data do not allow a comparison of substance use prevalence and related factors by zone. This study aims to describe knowledge, attitudes, beliefs, risk perceptions, skills and substance use behaviors among Nigerian secondary school students, underlining differences by geopolitical zones. Methods: The population size of the zones was taken into account in extracting the schools for the study. 32 schools were invited and participated: 6 in NW, 4 in NE, 4 in NC, 2 in FCT, 8 in SW (of which 2 in Lagos), 4 in SE, 4 in SS. A self-completed anonymous questionnaire was created ad hoc for the survey. The questionnaire investigated characteristics of the social environment, tobacco, alcohol and substance use, knowledge, beliefs, and attitudes about substances, the perception of peers and friends use, personal skills and school climate. Results: 4,078 adolescents (66.4% males) participated in the survey. The mean age was 14.7 years. On average 5.1% of pupils smoked cigarettes at least once in their life, 33.6% drank alcohol, 13.1% had drunkenness episodes, 7.5% used cannabis and 11.6% other illicit drugs, with differences between zones. The highest rates of alcohol use were observed in Lagos and Southern zones, whilst cigarettes, cannabis and other drug use were higher in Northern zones. Knowledge on tobacco, alcohol, and marijuana use were quite low across all zones. Self-esteem, decision-making and refusal skills, risk perceptions and beliefs were lower in students of Northern zones. Conclusions: The prevalence of adolescent alcohol and substance use in Nigeria is not radically different from that of developed countries. Drug education and prevention activities should be planned and implemented across the country in case of alcohol, and special attention should be paid to cannabis and other illicit drugs in Northern zones. Prevention activities among adolescents can help to reduce the burden of disease related to cigarettes, alcohol, and drugs in adult ages.