1 EFFECTIVENESS OF DRUG AND SUBSTANCE ABUSE PREVENTION PROGRAMS IN SELECTED PUBLIC AND PRIVATE UNIVERSITIES IN KENYA. BY KEMEI C. RONOH, (MA) C82/11040/08 A THESIS SUBMITTED TO THE SCHOOL OF HUMANITIES AND SOCIAL SCIENCES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF DOCTOR OF PHILOSOPHY IN COUNSELING PSYCHOLOGY OF KENYATTA UNIVERSITY. October, 2014
2 i DECLARATION This Thesis is my original work and has not been presented for any examination in any university or any other award Signature: Date Kemei C. Ronoh (C82/11040/08) Department of Psychology Supervisors: We confirm that the work reported in this thesis was carried out by the candidate under our supervision Signature: Date Margaret K. Mwenje (PhD) Department of Psychology Karatina University Signature: Date Wilson A. P. Otengah (PhD) Department of Sociology and Psychology Rongo University College
3 ii DEDICATION Children, Youth, Adults, Parents and Researchers whom we together should see the need to defend our great potential through a reasoned fight against Drug Abuse in our society.
4 iii ACKNOWLEDGEMENTS I wish to express my special gratitude to my Supervisors, Dr. Margaret Mwenje and Dr. Wilson Otengah for their candid supervision, insight, timely response to my inquiries, guidance, unchallenged support and commitment. I have a message to them in form of a quote We are like dwarfs on the shoulders of giants, so that we can see more than they, and things at a greater distance, not by virtue of any sharpness on sight on our part, or any physical distinction, but because we are carried high and raised up by their giant size." (Bernard of Chartres, 1130 AD). The Corrections Supervisor, Dr. Christine Wasanga did fantastic job to make it possible for the thesis to obtain professional structure. I greatly appreciate her great effort and commitment. I appreciate the Vice- Chancellors of the Universities under study for the permits and support. It is through this that comparison of valuable information was obtained. I thank my Colleagues in the PhD Pioneer class for the cordial relationship, insights and support we shared together during the Course Work, Practicum and Thesis Research. To my Family; my husband, David Ronoh and our children, I sincerely thank them very much for their continuous love, understanding and support. Definitely, without this kind of a family, I wouldn t have carried out my studies. I treasure them greatly. Sr. Nganda, a very special friend, I heartily appreciate her generous provision of love encouragement and support always and particularly at the beginning of my study. Many other people also in big or small ways contributed to the completion of this study. To all these great people, may our Almighty God, love, keep and increase them.
5 iv Table of Contents DECLARATION... i DEDICATION... ii ACKNOWLEDGEMENTS... iii Table of Contents... iv List of Tables..ix List of Figures.x Operational Definition of Terms...xii Abbreviations and Acronyms... xiv ABSTRACT...xv CHAPTER ONE: INTRODUCTION Background to the study Statement of the problem The Purpose of the study...12 The purpose of this study was Specific objectives: Research questions Hypotheses of the study Justification of the study Significance of the study Assumptions Scope and delimitation...17 CHAPTER TWO: LITERATURE REVIEW Introduction Theoretical Framework...19
6 v Self-Efficacy Theory (Bandura, 1986) Ecological Systems Theory (Bronfenbrenner, 1944) Review of literature Objectives, Levels and Principles of Prevention Programs Drug and Substance Abuse Prevention Programs Drug and Substance Abuse Prevention Programs in the US Universities Drug Abuse prevention programs in Universities Drug and Substance Abuse Prevention Programs in European Universities Drug and Substance Abuse Prevention Programs in Asian Universities Drug and Substance Abuse Prevention Programs in African Universities Substance Abuse Prevention programs in Kenyan Universities Conceptual framework...58 CHAPTER THREE: RESEARCH METHODOLOGY Introduction Research design Variables Site of study Target Population Sample size and sampling techniques Research Instruments Pilot study Data collection Procedures Validity and Reliability Data analysis techniques Data Management and Ethical Considerations...72
7 vi CHAPTER FOUR: DATA ANALYSIS, PRESENTATION AND DISCUSSION Introduction Demographic information of Respondents Respondents Gender distribution University Faculties Respondents Year of Study Respondents residence Findings of the study Prevention programs and activities currently at work in the university Objectives of Prevention Programs Methods of Program Implementation Availability of Resources Display of DSAPP activities Coordination amongst prevention providers Departmental Involvement DSAPP impact on drug abuse prevention Rating on DSAPP implementation methods Suggestions on more popular and useful DSAPP methods Student participation in and utilization of prevention programs Student Drug and Substance Abuse Prevention programs Student Participation Strategies which enhance Students utilization of DSAPP Challenges to effective implementation of DSAPP DSAPP Challenges Target of factors which sustain Drug and substance abuse...140
8 vii Aspects of drug abuse sustaining factors Youth Drug Culture Suggestions on effective drug abuse mitigation Summary of the findings CHAPTER FIVE: SUMMARY, CONCLUSIONS AND RCOMMENDATIONS Introduction Summary Demographic information of research respondents Objectives of prevention programs currently at work in universities Program implementation Student participation and utilization of prevention programs Challenges to effective implementation of DSAPP Drug abuse sustaining factors Conclusion Demographic Characteristics of respondents Prevention levels and objectives Program implementation Student responsiveness to prevention programs Challenges facing DSAPP Drug abuse sustaining factors Recommendations Suggestions for further research Appendix A: Introduction Letter and Consent Form Appendix B: Questionnaire for Students
9 viii Appendix C: Focus Group Discussion Guide Appendix D: Qualitative Interview Schedule Appendix E: Structured Observation Guide Appendix F: Study Process Framework Appendix G: Reasons for lack of DSAPP awareness Appendix H: Prevention activities and services Appendix I: Suggestions on effective communication of DSAPP messages Appendix J: Suggestions on more popular and effective methods Appendix K: Reasons for rating on student participation Appendix L: Challenges facing DSAPP Appendix M: Drug abuse sustaining factors Appendix N: Suggestions on effective ways to address ADA...221
10 ix List of Tables Table 2.1 Prevention levels and interventions...35 Table 3.1 Sample size and sampling techniques...59 Table 3.2 Schedules of Research Tools administration 62 Table 4.1 Student enrolment in universities by sex...69 Table 4.2 Mean scores for drug abuse prevalence in universities...73 Table 4.3 Demographic information of respondents Table 4.4 Programs objectives...83 Table 4.5 Chi-square Test.. 94 Table 4.6 Reasons why DSAPP had actively involved their departments 95 Table 4.7 Chi-square Tests..102 Table 4.8 Student groups which carry out DSAPP activities Table 4.9 Rating of student participation Table 4.10 ANOVA tests on rating..111 Table 4.11 Reasons for students rating on participation Table 4.12 Chi-square Tests 117 Table 4.13 DSAPP strategies that could enhance students' utilization Table 4.14 ANOVA Tests 121 Table 4.15 Reasons why students think DSAPP do not face challenges.125 Table 4.16 Suggestions on how to address challenges facing DSAPP Table 4.17 Ranking of social, economic, psychological and youth culture Table 4.18 Means of factors sustaining drug abuse.135 Table 4.19 ANOVA tests on rating of causes of drug abuse Table 4.20 Factors of drug abuse that have not been adequately addressed Table 4.21 Understanding of drug youth culture...152
11 x List of Figures Figure 2.1: Conceptual Framework...60 Figure 3.1: Data analysis process...71 Figure 4.1. Distribution by Gender...68 Figure 4.2: Year of study by universities...71 Figure 4.3: Students residence by universities...72 Figure 4.4: Ways DSAPP carry out their activities...75 Figure 4.5: The Precede-Proceed Model...78 Figure 4.6 Awareness of DSAPP...79 Figure 4.7 Reasons why students were not aware of DSAPP 81 Figure 4.8: DSAPP messages display Figure 4.9: Suggested communication avenues...97 Figure 4.10: Berlos SMCR model of communication...99 Figure 4.11: DSAPP Involvement with other departments...94 Figure 4.12: Reasons for departmental involvement...98 Figure 4.13: Reasons for lack of departmental involvement Figure 4.14: DSAPP impact on substance abuse prevention Figure 4.15: Rating of implementation methods Figure 4.16: Methods which could be more popular and useful Figure 4.17: Ways DSAPP could improve their services Figure 4.18: Awareness on DSAPP Student groups Figure 4.19: Knowledge of student groups that carry out DSAPP activities Figure 4.20: Ratings on whether students should be used as agents of DSA Figure 4.21: DSAPP strategies that can enhance students' utilization...130
12 xi Figure 4.22: Knowledge on whether DSAPP face challenges Figure 4.23: Challenges facing DSAPP Figure 4.24: Suggestions on how to address DSAPP challenges Figure 4.25: Other aspects in students lives causing drug abuse Figure 4.26: Youth Drug Culture Figure 4.27: Suggestions on effective ways to deal with drug abuse...156
13 xii Operational definitions of terms Assessment refers to a detailed way of gathering information about how prevention programs at the university meet the criteria for effectiveness Drug and Substance Abuse refers to inappropriate use of intoxicating drugs to an extent that personal, academic, social and spiritual functioning is disrupted. Effectiveness refers to the presence, usefulness and capacity of drug and substance abuse Prevention Programs and activities to encourage university members to promote constructive lifestyles and avoid drug and substance abuse. Levels of prevention programs refer to different categories of prevention activities targeting drug users and abusers at different stages of drug use and abuse. Lifestyle is an inclined mode of living which is influenced by specific attitudes, interests, habits, preferences and behaviors which arise spontaneously in most cases. Prevention refers to the diverse approaches through which the university community promotes constructive attitudes, norms, beliefs, values, practices and life choices to build against substance abuse. It refers to all the activities in addiction continuum employed by the university to help its community members from engaging, progressing and staying in drug addiction. Student Responsiveness is students awareness, receptiveness and attitude towards
14 xiii prevention activities including their participation in drug abuse prevention programs. System refers to a complex of interacting components together with the relationships which contribute to various webs and hubs of reactions and behaviors
15 xiv Abbreviations and Acronyms AA ADA ADCU DSAPP FGD GOK ICL LST NA NACADAA NIDA Alcoholics Anonymous Alcohol and Drug Abuse Aids and Drug Control Unit Drug and Substance Abuse Prevention Programs Focus Group Discussion Government of Kenya I Chose Life Life Skills Training Narcotics Anonymous National Campaign Against Drug Abuse Authority National Institute on Drug Abuse PUU1 Public University 1 PUU2 Public University 2 PRU1 Private University 1 PRU2 Private University 2 QIS SCAD SHED SOG SPSS SSSP WHO Qualitative Interview Schedule Student Campaign Against drugs See, How, Empower, Do Structured Observation Guide Statistical Package for Social Sciences Social Support Service Providers World Health Organization
16 xv ABSTRACT Substantial outcry about the problem of drug and substance abuse and its rippling effects echoes from many sectors of the society today. Families, learning institutions and places of work undergo agonizing consequences of drug abuse. In the university, the problem is rampant aggravated by many factors such as personal independence, a lot of free time, a wide range of demands on the individual student, psychosocial impact of interpersonal interactions, transition to university life and making new peers. Drug and substance abuse impacts negatively not only on student abusers and the university goal attainment but also causes problems to students who don t abuse drugs, their families and care providers. In response to this problem, universities have established prevention programs and Social Support Services to implement interventions. Information from the literature review demonstrates that some prevention programs can be effective whereas others may not be. This study sought to assess effectiveness of drug abuse prevention programs in selected Public and Private Universities in Kenya with specific objectives which were to establish; objectives of various levels of prevention programs and activities, implementation methods, student utilization of prevention activities, challenges facing prevention services and factors which sustain drug abuse in the universities. Self-efficacy and Ecological Systems Theories including principles for effective prevention programs endowed insight into this study. It was a cross-sectional survey applying both qualitative and quantitative techniques to benefit from their complementary nature. This study was carried out in 2 Public and 2 Private Universities in Kenya. Multi-stage sampling techniques were employed in selection of 499 respondents consisting of 395 students and 104 Social Service Providers. Four data collection tools consisting of Student Questionnaire, Focus Group Discussions, Qualitative Interview Schedule and Structured Observation Guide were used. Data analysis was done with the aid of SPSS and NVIVO 10. Findings revealed homogeneity in respondents characteristics and use of drug abuse (Chi-square P-value, 0.145) amongst universities under study. Findings demonstrated that primary prevention level was the predominant intervention activity with low rate (30.8%) student awareness of prevention programs and activities. It also showed poor student participation (14.1%), inadequate resources, poor implementation methods and negative student attitude being the major challenges to effective implementation. Study findings revealed that drug abuse is sustained by factors related to social, psychological, economic and cultural. The study recommended to DSAPP to apply scientifically based approaches. It recommended to the University Management provision of comprehensive support to DSAPP. It was recommended to NACADA to strengthen personnel training and dissemination of information at all educational levels and in all counties. This study also recommended to the Ministry of Education to integrate Drug abuse courses in the curriculum in all education levels from Primary to the university. Suggestion for further research should target specific drugs and prevention models which are contextual to universities in Kenya.
17 1 CHAPTER ONE INTRODUCTION 1.1 Background to the study The problem of substance abuse is considerably rampant in universities with increasing trend for the last over a decade as evidenced by a study carried out in one of Kenya s private universities which revealed percentages of lifetime rates of commonly used substances at; tobacco 54.7%, alcohol 84.2 %, cannabis 19.7% and inhalants 7.2% (Ogunde, & Leak, 1999; Atwoli et al.(2011). In a 2013 study in public universities, this trend is persistent with tobacco rising to 69.5 % (Magu, Mutugi, Ndahi & Wanzala, 2013). Evidence (Mwenesi, 1996, Lutomia & Skolia, 2002, NACADA, 2002, 2004) demonstrates that majority of drug abusers in Kenya are students in schools and universities especially in the cities of Nairobi, Mombasa and Kisumu. Oteyo & Karuiki (2009) echo out use of alcohol which has evolved over time into a problem of dependence and addiction with the youth getting more and more involved in consumption of illicit drugs. NACADA (2009) survey revealed that 10.6% respondents smoke bang, while over 11% of Kenyan youth use Miraa. Adverse impact of drug abuse is great as UNDCP (2002) sums up that, Drugs destroy lives and communities, undermine sustainable human development and generate crime. Further, drugs affect all sectors of society in all countries and in particular; drug abuse affects freedom and development of young people, the world s most valuable asset. Further, drugs are a grave threat to the health of all mankind, the independence of states, democracy, the stability of nations, the structure of all societies and the dignity and hope
18 2 of millions of people and their families. Ray & Ksir (2002) strongly support this fact that alcohol and other drug use is a factor in many accidents, injuries, vandalism, and crime on campuses and is frequently a key factor when students encounter problems with their coursework. Ironically, even college students who avoid the unsafe use of alcohol and other drugs still suffer the effects of the high-risk behaviors of their peers such as conflicts or having to take care of their drunken colleagues. The World Health Organization (WHO) have stated that by the year 2020 mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide (WHO, 2008). WHO (2013) further emphasizes that at least 15.3 million individuals have drug use disorders and drug abuse are associated with significant health and social problems. NACADA (2012) views many risks associated with the problem of drug abuse including; dependent young adults, increased health care needs amongst the youth abusing alcohol and drugs and crimes resultant from idleness and the youth s drinking habits. Several psychosocial and environmental factors combine to aggravate and sustain habitual drug and substance abuse at the university. These include personal independence, a lot of free time, a wide range of demands on individual student, psychosocial impact of interpersonal interactions, academic demands and societal transitions such as leaving home, developing autonomy, making new friends and peers (Larimer et al., 2005; University of Nairobi, 2010). These factors also have an interlocking impact in determining student efficacious response to substance abuse prevention programs in the university.
19 3 Drug Abuse Prevention Programs are tools designed to enable users avoid or decrease unhealthy drug use through focusing on different motivations individuals have for using and abusing specific drugs at different ages (Insel, Roth, Rollins & Petersen, 2012). UNDCP (2002) define prevention as an intervention designed to change the social and environmental determinants of drug and alcohol abuse including discouraging the initiation of drug use and preventing progression into more regular use among at-risk populations. Prevention is one of the positive health behaviors (Mrazek & Haggerty, 1994). Prevention in this study refers to the diverse approaches through which the university community promotes constructive attitudes, norms, beliefs, values, practices and life choices to impede drug abuse. It refers to all the activities in addiction continuum employed by the university to help its community members from engaging, progressing and staying in drug addiction. Public Health Model (Mrazek & Haggerty, 1994; Ayah, 2011; Kloos, et.al, 2012) on prevention delineates three levels and characteristics of prevention which this study examined for their presence in the programs of the universities under study. The beginning of drug abuse prevention programs in institutions and communities dates back to Shanghai Opium Commission in 1909 when the groundwork for the first International Drug Control Treaty was established. This was followed by the International Opium Convention of The Hague, 1912 which laid the ground for various studies that came up with recommendations for prevention. This study considers assessment of effectiveness of drug abuse prevention programs a strong rejoinder which provides an avenue for bridging the gap between the existing
20 4 knowledge about prevention and the practical implementation as well as grasping the demarcation between effective and non-effective prevention programs in Kenyan universities. Laurie (1984) delineates that the goal of research is to expand knowledge about how existing prevention programs actually operate, which programs have been effective and why and whether these programs are transferrable to other settings. Evidence from epidemiology according to a survey done by (NIDA, 2009) suggests continuous shifts between periods of increasing and decreasing abuse of substances because prevention can modify the trend, generate or reinforce the downward shift, or help diminish the rising trend. This fact is reiterated by results of a comparative study carried out at Gaza strip in 2004 and 2008 demonstrating changes in drug use prevalence found reduced as follows: marijuana, 2.5 percent of males and 0.8 percent of females compared with 4.6 percent and 1.2 percent, respectively, in 2004; alcohol, 3 percent of males and 5 percent of females compared with 7.1 percent and 2.6 percent, respectively; powder (heroin and cocaine), 1.2 percent of males and 0.3 percent of females instead of 2.8 percent and 1.6 percent, respectively. However, tablets were reported to increase and new tablets were reported: Tramadol, 7.8 percent for males and 2.5 percent for females; central nervous system stimulants, 5 percent for males and 1.5 percent for females compared with 5.4 percent and 1.3 percent, respectively (AlAfifi, &. AlSakka, 2010). (AlAfifi, &. AlSakka, 2010) argue that changes in substance abuse trends are due to reduced amounts of planted marijuana due to improved control on planting and the increased supply of smuggled Tramadol tablets, which has increased demand for this medication that is used by young people of both sexes without prescription. Hawkins et
21 5 al. (2002) suggest utilizing an empirically sound diagnostic tool for assessing risk and protective factors in order to identify factors for prioritization to be harmonized with effective prevention efforts. Assessment of effectiveness of prevention programs in Kenyan universities would offer a reflection necessary in reducing substance abuse which in turn positively impact on accomplishment of universities vision through improved academic performance, reduced student indiscipline and dropout cases, improved relational dynamics and enhancement of student participation in extra-curricular activities. A paradigm shift of this nature can only be achieved through articulate consideration on how prevention programs operate including looking at factors responsible for effective and non-effective prevention programs. Scientific evidence demonstrates effective prevention programs as those with multiple approaches and attributes such as; placing emphasis on socio-cultural relevance to users, aiming at modifying risk and protective factors, are developmentally relevant in getting to the intellectual, cognitive and social levels of participants, employing comprehensive life skills, have interpersonal skills and interactive activities amongst users and implementers, and are theory driven (Dusenbury & Falco, 1995, Tobler 2000, Riggs, 2003, Nation, et.al, 2003). Riggs (2003) proposes intervention measures such as; strengthening academic requirements, restricting alcohol promotions and advertising on campus, providing a wide range of alcohol-free social and recreational activities. Research also suggests matching individual characteristics with a specific approach and those approaches that will attract
22 6 university students to see the need to mitigate the problem of drug abuse (Battjes & Bell, 1985, Jones 1990, Ghodse, 2005). Bukoski (2006) recommends that prevention programs for students should include integrative methods such as peer discussion groups and not just didactic teaching techniques. He supports programs that integrate skills which enable students resist drugs when offered, strengthen personal commitment against drug use and increase social competency of assertiveness and self-efficacy. Research vividly shows further that strategies designed to mitigate substance abuse problem are geared towards targeting psychological, social, cognitive and behavioral components of student interactions. These constitute good suggestions on methods of delivery and fundamental areas to focus on in order to ensure effectiveness of prevention programs. In America, The Higher Education Center for Alcohol and Other drugs and Violence Prevention was established to spearhead prevention through programs like Drug Abuse Resistance Education (DARE), Alcohol and Drug Abuse Prevention Team (ADAPT) and Students Taught Awareness and Resistance (STAR). These programs disseminate information and address student psychosocial behavior at multiple levels such as personal, peer, institutional and community. They include provision of mutual counsel, encouragement and mentorship. Through these programs, some students have abstained from abusing drugs (Stubbs, 2008). Assessment of prevention programs in Kenyan universities to establish ability and viability of targeting prevention epitome through accessibility and modification of drug taking behaviors of students is paramount in determining the effectiveness of student utilization of prevention services drug abuse reduction.
23 7 Utilization of extracurricular activities to prevent risky behaviors including alcohol and drug use among adolescents, university students and adults prove effective in reducing drug abuse cases. Incorporation of Games and Sporting activities in prevention programs may augment effectiveness. It also encourages students to participate in antidrug abuse campaigns in UK universities (Larson, 2000, Eccles et al., 2003, Murphy et al., 2005). In Chinese universities prevention of drug and substance abuse aims at replacing attitudes of reckless socialization with a sense of responsibility in social relationships. This enhances collaboration among students in working against drug abuse (Abdullah, Fielding Hedley, 2010). Promotion of positive attitudes for concerted effort towards drug abuse reduction among university students would be crucial in instigating effectiveness of substance abuse prevention programs. At the University of Deakin in Australia, student drug and substance prevention activities reinforce the government s prevention effort through integration of a unit which tackles drug abuse information in academic programs. This has increased positive responsiveness to drug abuse prevention amongst students (Lewis, 2010). Integrating drug and substance abuse prevention programs with academic activities has proven effective in the fight against drug abuse. Kenya universities integration of prevention activities in academic programs would expand the scope of recipient information hence augment prevention effectiveness. In Rwandan universities, students and staff utilize a radio program to disseminate information on drug abuse prevention. Other strategies include anti-drug campaign weeks (Ngabonziza, 2011). In Uganda, the Prevention of Alcohol and Drug abuse (PADA)
24 8 founded by Makerere University, students with support from other agencies such as the Ministries of Gender, Health and Education spearhead. Drug abuse prevention activities include empowerment on psychosocial skills for drug abuse prevention, advocacy and research for social change (Henning, 2011). PADA has encouraged university students to participate in reduction of drug abuse amongst their colleagues. This kind of program has been more effective than the ones that don t encourage students participation since participation makes them own the programs. This would provide a good example to Kenyan universities prevention programs in emphasizing social change for support and involvement in prevention programs amongst students. In Kenya, The National Agency for Campaign Against Drug Abuse (NACADA) founded in 2001 with a mandate to prevent substance abuse collaborates and partners with universities. It has provided empowerment to youth and general public on how to counter drug abuse in learning institutions including universities. NACADA carries out training of counselors to help in the prevention of substance abuse. Other programs are offered by the media, Non-Governmental Organizations (NGOS) and spiritual leaders, all of which make attempts to prevent substance abuse in Kenyan institutions including universities through provision of life skills, dissemination of information and skill development. Most strategies entail dissemination of information about drug abuse and its consequences and empowerment on social skills for resisting drug use and abuse. Through these trainings, production of materials for dissemination of information and other activities, substance abuse prevention in Kenyan universities is undergoing prevention.
25 9 Foregoing information depicts various universities efforts to address substance abuse problem. These efforts entail huge financial investment through production of materials, implementation procedures and employment of counselors and other social support providers. A fundamental question that inevitably emerges is the state of discrepancies in prevention programs to an extent of still a rising prevalence rate despite all these exertions in Kenyan Universities. In response to this inquiry, this study embarked on assessment of effectiveness of substance abuse prevention programs in selected Public and Private Kenya universities. Apparently, measures of effectiveness of drug abuse prevention programs are multifaceted, but this study adopted two strategies to address it. First, it identified principles of effective prevention programs which have been established after several years of research from renowned drug abuse prevention bodies namely, US National Institute on drugs (NIDA) and The Mentor Foundation, UK and individual research scholars. Representation of different regions of the world was put into consideration while selecting these researches to gain from divergent contexts, a strong factor influencing effectiveness of substance abuse prevention programs. These researches spanning over several research years offer scientific-based findings on effective principles for fundamental ideals in establishing workable prevention programs. Secondly, elements assumed relevant and worthy examining were operationalized in order to obtain a clear picture of how prevention programs in Kenyan universities combat drug abuse. These consist of; objectives of various prevention programs present, methods of service delivery, material and human resources, suitability of prevention programs to users psychosocial and socio-cultural attributes, availability of prevention services to users, synchronization of prevention programs to other university academic
26 10 and non-academic programs, student responsiveness, challenges encountered by prevention programs and factors sustaining drug abuse. Study process framework based on these parameters to aid in expedition of prevention programs in Kenyan Universities was purposefully developed to guide in examining variables deemed essential (Appendix F). Each parameter has details of program expectations which according to this study deserved to be investigated as portrayed in research findings that capacity of drug abuse prevention programs to infiltrate and implement these parameters constituted an indication of effectiveness (Naidoo & Wills, 2011, Kloos et.al 2012). 1.2 Statement of the problem Attempts to address substance abuse dates decades back in Kenya as demonstrated by the following series of steps; The Kenya Ministry of Education in its reports (Ominde, 1964, Gachathi, 1976, Koech, 1994); establishment of NACADA in 2001; legislation overseeing the cultivation, trafficking and abuse of legal and illegal drugs in Kenya (NACADA 2002). Contracting performance of State Corporations (GoK 2003) which saw recommendation of prevention of drug abuse in universities resulting in strategy which has since ensured employment of counsellors, training of drug and substance abuse trainer of trainers (TOTs) and establishment of workplace drug abuse policy; the government implementation of United Nations Millennium Development Goals and the Vision 2030 (GoK 2007) all depict measures to curb drug abuse in Kenya through various prevention programs. In universities in Kenya, substance abuse prevention programs are provided by social support systems such as counselling, chaplaincy, coaching, and mentorship who closely work with students in providing life skills education, support and coping strategies.
27 11 Through academic programs and auxiliary services, the university endeavors to keep students on academic agenda and make the university the serene world of academia with goals of teaching, learning, and research and community outreach services. Furthermore, universities incur a lot of financial expenses through prevention programs. The strategic plans covering five years for NACADA (2009) and the Ministry of State for Youth Affairs (GoK, 2007) on budgets for drug abuse prevention which is estimated at Ksh 820,860,308 and 160, respectively demonstrate huge amounts of money spent on drug abuse prevention programs. However, information on the status of drug abuse shows a rising trend. National Baseline survey on Alcohol and substance abuse in learning Institutions (2009) illustrates an increased use as education level advances. At primary school level, alcohol consumption is at 10.3% whereas at secondary school level it shoots to 29.5%. Cigarette smoking at primary school level was 10.2% whereas secondary school was 17.9%. A baseline survey carried out by Kenyatta University (2009) demonstrated that 24% of students use alcohol while other drugs consumption is above 10%. Atwoli, Mungla, Ndungu, Kinoti & Ogot, (2011) quotes a lifetime prevalence rate of 69.8 %. College of Health Sciences at University of Nairobi demonstrates 52.6% of students use alcohol and 14.6% showed symptoms of dependence (UoN, 2010). Squirting trend and repercussions of university students drug abuse is further evidenced by Kenya Police department reports. A few cases from Nairobi Central Police Station in their daily occurrence books reveal that in February 2002, students of University of Nairobi after drinking at club Heatz at Moi Avenue beat up customers, in 2006, students of Kenya polytechnic caused chaos after drinking at Juzz club, in 2009, students from Jomo Kenyatta University of Agriculture
28 12 and Technology caused problems after drinking at Black Diamond club, in 2011,students of United states International University went on rampage after drinking at club Beltz and in January 2012, university of Nairobi students were arrested at Cocoa lounge after being found smoking cigarettes. The above information substantiates a contest between drug abuse prevention efforts stretching from 1960s to the present involving weighty human and financial investment and drug abuse rising trend. Hence it is in the light of the above premises that this study seeks to assess the effectiveness of substance abuse prevention programs and activities in selected Public and Private Universities in Kenya. 1.3 The Purpose of the study. The purpose of this study was to assess effectiveness of drug and substance abuse prevention programs in selected Kenyan Public and Private Universities. 1.4 Specific objectives: The specific objectives were: 1) To establish objectives, levels and principles of drug abuse prevention programs and activities currently in existence in universities. 2) To establish methods of implementation of drug abuse prevention programs in universities. 3) To determine student utilization of and participation in drug abuse prevention programs and activities in universities
29 13 4) To establish challenges to effective implementation of drug abuse prevention programs in universities. 5) To find out if prevention programs and activities target factors which sustain drug abuse in universities. 1.5 Research questions The research questions which guided this study were: 1) What are objectives, levels and principles of drug abuse prevention programs in existence in the universities? 2) What are the implementation methods of drug abuse programs in the universities? 3) Do students utilize and participate in drug abuse prevention programs and activities in the universities? 4) What are the major challenges facing effective implementation of drug abuse prevention programs in the universities? 5) Do prevention programs and activities target factors which sustain drug use and abuse in universities 1.6 Hypotheses of the study This study employed Hypothesis testing on research sections which needed clarification and comparison of findings amongst universities and between public and private universities under study which included: 1. H 0 : There is no significant relationship between students awareness of DSAPP and their residence.
30 14 2. Hα: There is no significant difference in use of drugs amongst students in Private and Public Universities 3. H o : There is no significant difference in DSAPP departmental involvement in Public and Private Universities 4. H o: There is no significant difference in opinion about the impact of DSAPP on drug abuse prevention amongst respondents in universities under study. 5. Ho There is no significant difference between ratings on student participation in selected universities 6. Ho: There is no significant statistical difference in students being used as agents of prevention in Public and Private Universities under study 7. Ho: There is no significant difference in strategies suggested for greater utilization of prevention programs in selected Public and Private universities 8. Ho: There is no significant difference in the rating of social, cultural, psychological and economic as factors sustaining drug abuse in selected universities. 1.7 Justification of the study Assessment of effectiveness of prevention programs could help identify benefits and challenges for prevention programs appropriate adjustment. Drug abuse has agonizing social, physical, spiritual, emotional and financial consequences on the abuser, their families and the university s vision and mission. Substance abuse continues to impact negatively on academic performance, making the victims frustrate their roommates and
31 15 caretakers. Students who abuse drugs take longer periods of study or even drop out of the university. Assessment of effectiveness of prevention programs is crucial in unveiling workable strategies which the university stakeholders could apply to avert substance abuse and its adverse impact. Recovery from drug addiction is costly for families, the university and the government as Sloboda & Bukoski (2006) evidently put it that effective prevention program is costeffective since for every dollar spent on drug use; communities can save 4 to 5 dollars in costs for drug abuse treatment and counselling. NIDA (2009) measured the costeffectiveness and benefit-cost of two long-term, effective intervention programs known as Strengthening Families Program: For Parents and Youth (SFP 10 14) and Guiding Good Choices (GGC) program. For every dollar spent on SFP, a $10 benefit was measured, and for every dollar spent on GGC, a $6 benefit was measured. Earlier studies also reported that for every dollar spent on drug abuse prevention programs in general, communities saved from $4 to $5 in costs for treatment and counselling programs. Preventing drug use before it begins is a cost-effective, common-sense approach to promoting safe and healthy communities (UNODCP). Obot (1993) retorts that economic cost of drug abuse are enormous with Egypt spending 6.6 billion US dollars annually on efforts to combat them through cost of treatment, loss of productivity and the social and health complications. The Ministry of State for Youth Affairs and NACADA in Kenya collectively spend approximately Ksh 180 Million annually on drug abuse prevention. It is on the basis of the above detrimental financial and psychological incurrence that this
32 16 study sought to assess the effectiveness of substance abuse prevention programs in selected Public and Private Kenyan universities. 1.8 Significance of the study Through effective prevention programs, the university being a nurturing institution for highly qualified scholars and as the point of departure for students to the world of work, it is ably suited to inoculate a drug abuse-free culture. The university setting provides an opportunity for reaching a large number of young people and equipping them with knowledge, skills and attitudes to enhance not only their personal health but also that of the families they will establish and the communities in which they will live and interact with (Kupchella, 2009 in Fertman & Allensworth, 2010). Assessment of effectiveness of prevention programs enables adequate understanding of variables surrounding drug abuse dynamics. This is quite significant for formulation and amendments of drug abuse policies for improvement in universities. In the perspective of this study, it is only effective prevention programs that have the capacity to accurately trace the nub of drug and substance abuse prevention. Assessment of effectiveness was therefore found necessary to create room for refinement and depict prevention hallmarks. It was envisaged that through the findings of this study, prevention program implementers would be able to pay adequate attention to relevant environmental, social and personal predispositions which play a key role in drug and substance abuse prevention. The findings of this study on what constitutes effective prevention programs could greatly contribute a positive change in the practice of substance abuse prevention which could be
33 17 replicated in other learning institutions. Effective interventions may help prevention practitioners select, modify or create more effective programs. 1.9 Assumptions This study was based on the assumptions that: 1. Substance abuse is a phenomenon entrenched in student lifestyle dynamics with universities responding by establishing drug abuse prevention programs whose comprehensive and integrated approaches are required for effectiveness. 2. Drug abuse prevention in the university is not a statutory requirement because they do not constitute the core functions. Support of prevention programs hence are dependent mainly on the will of the university as alluded to by (Polymerou, 2007). 3. The triangulation of data collection methods was strategic to an enriched study Scope and delimitation This study was carried out in two Public and two Private universities in Kenya. It integrated students and social support providers consisting of counsellors, chaplains, wardens, security officers and Housekeepers working. Four tools of data collection consisting of Student Questionnaire, Focus Group Discussions and Qualitative Interview Schedule. In all these research tools, synthesis of information targeted operationalized parameters which were considered indicators of effectiveness as derived from the literature review namely; programs and activities present in universities including their levels, objectives and principles. Other parameters were, methods of implementation, resources, student utilization of and participation in prevention programs, suitability of prevention programs to users psychosocial and socio-cultural attributes and challenges encountered by prevention programs.
34 18 However, prevention activities targeting specific drugs of abuse such as heroin, cocaine and emerging drugs were not done to avoid too much breadth and allow for adequate attention to major domains identified in the objectives of this study. It is for the same reasons that assessment of specific prevention programs such as NACADA, ADCU, SCAD, NGOS, FBOS or any other organizations related directly or indirectly to prevention efforts in universities was not done.
35 19 CHAPTER TWO LITERATURE REVIEW 2.0 Introduction The purpose of this study was to assess effectiveness of drug abuse prevention programs in selected Public and Private Universities in Kenya. This chapter presents theoretical framework of the study based on Self-Efficacy Theory (Bandura, 1986) and Ecological Systems Theory (Brofenbrenner 1944) and other augmenting theoretical frameworks and concepts. It discusses literature review, on researchers findings on drug abuse prevention programs over time in World, African and Kenyan universities. These prevention programs discuss their effectiveness in reducing drug abuse behaviors. Principles for effective prevention programs emanating from Dusenbury & Falco s (1995) evaluation of several drug abuse prevention programs provide basis to discourses in this section. The Conceptual framework of the study comes at the end of the chapter delaminating major features of consideration in any effective drug abuse prevention program. 2.1 Theoretical Framework This study specifically made use of two theories namely, Self-efficacy theory (Bamdura, 1986) and Ecological systems theory (Bronfenbrenner, 1944) because their tenets demonstrated relevant relationship to the parameters measuring effectiveness and objectives of the study Self-Efficacy Theory (Bandura, 1986) This theory was proposed by Albert Bandura, a Psychologist born in 1925 at Alberta, Canada. Bandura (1995, 2004) perceived self-efficacy as beliefs in one s capacity to
36 20 organize and execute the courses of action required to manage prospective situations. Other researchers advance this point that, Self efficacy, or the confidence in personal ability, has been shown to predict a variety of health behavior outcomes (Ormrod, 2003; Margolis & McCabe, 2006; Conner & Norman, 2009). Bandura (1977) states that people s level of motivation affective states and actions are based more on what they believe than what is objectively true and for this reason, how people behave can often be better predicted by the beliefs they hold about their capacities than by what they are actually capable of accomplishing. According to him therefore, self-efficacy perceptions help determine what individuals do with the knowledge and skills they have. Bandura s theory is a pointer to an important situation that could emerge in universities in which established prevention programs may either be utilized by students or not. This dichotomous position is determined by the beliefs and attitudes they hold about the impact prevention programs create in their lives. Theory of Planned Behaviors (Fishbein & Ajzen, 2010) describes attitude as a disposition to respond favorably or unfavorably to an object, behavior, person, institution or event. Zimmermann (2008) argues that an elemental support of the effect of attitude on self-regulation is a dynamic process in which the individual engages as he or she works toward a goal. Without feedback or reflection, adjustments cannot be made and regulation of behaviors does not take place. He views the environment as an influencer to self-regulation in either a positive or negative direction. If the environment provides no feedback or social cues, it is difficult for effective self-regulation to take place.
37 21 This assertion indicates a complementary relationship between attitude and factors within the environment. If students positively appraise prevention programs, they are most likely to utilize them for their benefit. Conceptualization of student self-efficacy dynamics plays a big role in student positive responsiveness and participation in prevention activities. In this regard, student participation plays a key role in the implementation and effectiveness of prevention programs. Self-efficacy theory further postulates that, virtually all people can identify goals they want to accomplish, things they would like to change, and things they would like to achieve. However, most people also realize that putting these plans into action is not quite so simple. Bandura (1977, 2004) found that an individual s self-efficacy plays a major role in how goals, tasks, and challenges are approached. He argues that people with a strong sense of self-efficacy form a stronger sense of commitment to their interests and activities. Bird, Conrad, Fremont & Timmermans (2010) argue that personal control depends on one s choices and actions that they can master, control or effectively alter the environment. Luszczynska, & Schwarzer (2005) assert that choices affecting health are dependent on self-efficacy which determine whether health behavior change will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and failures. West (2006) in his cognitive bias theories argues that addiction is maintained by biases in the cognitive system, including beliefs, expectancies, selfefficacy, attributions and attention. Batholomew et al. (2006) argue that behavior change occurs in capability to perform the behavior or under a number of different circumstances like perceived self-efficiency and perceived behavioral control. The presuppositions
38 22 provide insight to prevention programs on the crucial need to develop self-efficacy among students. In universities, the success of prevention programs implementation is regulated by selfefficacy of individual students who are users of these programs. It is essential for prevention programs to access student cognitive dynamics for synchronization with techniques and strategies being used as this could contribute to effectiveness of substance abuse prevention Ecological Systems Theory (Bronfenbrenner, 1944) The proponent of Ecological theory is Urie Bronfenbrenner, a Russian American Psychologist born in Ecological systems theory provides a behavioral, environmental and socio-ecological approach to health promotion and prevention. This theory postulates that individuals, families and communities are not isolated entities but rather are an interrelated ecological system with each adapting to change that occurs in other parts of the organization (Guttmacher, Kelly, & Ruiz-Janecko, 2010). Bronfenbrenner (1944) proposes five systems which contain roles, norms and rules which play a big role in shaping individual development namely, Microsystems, Mesosystem, Exosystem, Macro system and Chronosystem. Microsystem refers to the immediate environment the individual comes from such as the peers, family and the neighborhood. A person's closest social circle consisting of peers, partners and family members do influence their behavior and contributes to their range of experience. Prevention strategies at this level may include mentoring and peer programs designed to reduce conflict, foster problem solving skills, and promote healthy
39 23 relationships. Mesosystem refers to the interactions between and among different Microsystems and the contexts that form them such as relationships among university prevention programs and the neighboring community. Exosystem demonstrates connection between social settings and the individual s immediate context. Individual Prevention strategies at this level are often designed to promote attitudes, beliefs, and behaviors that ultimately prevent substance abuse. Specific approaches may include education and life skills training. At macro system level, culture plays a crucial role in determining the way people exchange their relationships. Prevention strategies at this level are typically designed to impact the climate, processes, and policies in a given system. Social norm and social marketing campaigns are often used to foster community climates that promote healthy relationships. Chronosystem refers to the patterning of environmental events and transitions over the life of an individual. These factors include social and cultural norms. Other large societal factors include the health, economic, educational and social policies that help to maintain economic or social inequalities between groups in society. In a university setting, interactions exit at all the diverse levels mentioned by Brofenbenner (1944). Relationships exist among individual students, neighboring communities and the members of the entire university community. These relationships are determined by values, practices, beliefs, norms and regulations that deter or encourage drug use. It is necessary to approach substance abuse prevention from all these interacting factors so that thoroughness is achieved in reducing abuse. Botvin and Griffin (2007) summarizes this concept concerning campus environment that, perceptions of
40 24 campus use, campus climate, substance availability, awareness of campus policies and enforcement and students family histories of substance abuse impact the extent of drug use and abuse on any given campus. He emphasizes that the campus and surrounding community exert profound influence on innumerable facets of student life. Recognition of the environment in shaping and maintaining individuals' behavior is important in addressing individuals and the policies, practices, and social norms that affect them on campus or in the community. This is in line with (Margolis & McCabe, 2006; Conner & Norman, 2009) postulation of complementary interaction of aspects in ecological system. They enlist these factors as; intrapersonal factors consisting of characteristics of individuals themselves, such as knowledge, attitudes, behavior, self-concept, learning history, and skills; interpersonal processes and primary groups which constitute formal and informal social network and social support systems, including family, work group, living group, and friendship networks; institutional factors composing of social institutions to which individuals belong with particular organizational characteristics and formal and informal rules and regulations for operation; community factors which entail relationships among organizations, institutions, and formal and informal networks within defined boundaries and lastly, public policy on levels of local, state, and national laws and policies. Coreil (2010) suggests analysis within a social ecological framework at intrapersonal level which includes characteristics of individual such as knowledge, attitudes, behavior perceptions of risk and self-concept. He further advances that adolescent peer culture plays a key role in the development and maintenance of health risk behaviors.
41 25 Proponents of systems theory (Ludwig Von Bertallanfy, 1968, Bronfenbrenner, 1944,) advance several ideas through their basic concepts namely; that, a system interfaces with other systems that may be of a similar or different type., the functioning of a system affects multiple other systems and is effected by multiple other systems and that there is a constant interaction between systems resulting in a constant state of change. They contend further that time is a significant dimension and different effects occur over time. This is relevant to a typical university setting which goes through several changes as social and intellectual demands dictate. Ecological systems theory suggests fundamental principles underpinning multifaceted person-focused and environmentally based components in establishing prevention programs. In view of ecological systems theory, prevention programs need perceive highimpact leverage points and intermediaries that can facilitate successful implementation of prevention programs. It is essential as well for prevention programs to measure the scope, key players and sustainability of the outcome of prevention programs due to societal interactionism and functionalism (Weiss & Lonnquist, 2012). Rogers (2006) in support of these facts argues that when assessing and developing an intervention, there is need to consider all the factors that fall in the individual s life at all levels. The concept of individualism and collectivism hold relevance in community interaction (Myers, 2010). These precepts suggest that prevention programs need to consider various student psychosocial, behavioral and environmental characteristics which influence different levels of drug abuse prevention from the onset of drug use to addiction and recovery on individual and social basis at the university since individual health and behavior are influenced by their social and physical environment (Issel, 2004). It is relevant as well to
42 26 consider various changes that occur in availability, course and use of drugs of abuse at the university. Prevention strategies ought to give adequate consideration to the impact being created by drug abuse dynamism. This is practically possible if all the above mentioned concepts of interacting systems are examined to comprehend their role in drug abuse correlates. Changes take place in terms of entry, course and outcome of drug use. Attention on new ways in which drugs get accessed, used and camouflaged by students is important in determining prevention approaches useful to students who have not started using, or those already in use and those addicted to the problem. Attention needs to focus on new factors that sustain drug abuse in the university. Other researchers perspective strongly augment this theory attesting that prevention strategies should include dissemination of drug information, cognitive and behavioral skills training for youth, parents, and professionals among others(coreil,2010; Frost,2008; Ghodse,2005; Bandura,2004). Dusenbury & Falco, (1995); Riggs, (2003), contend that treatment and prevention for adolescents is most effective when multimodal treatment services are provided and integrated. Assessment of effectiveness of prevention programs should place special credence to levels of relationships, risk and protective factors present in the campuses in which students stay and carry out most of their formal, informal, academic and non-academic activities.
43 Review of literature The review of literature covered prevention levels, principles of prevention programs and prevention activities in World, African and Kenyan universities Objectives, Levels and Principles of Prevention Programs In various universities and drug abuse research centers such as National Institute on Drug Abuse (NIDA), Narconon International and Substance abuse Research Center at Jazan University, objectives of drug abuse prevention programs include but not limited to the following: 1. To reduce drug abuse in campuses and encourage a healthy lifestyle 2. To identify the characteristics and patterns of drug abuse. 3. To understand how, environment, and development influence the various risk and protective factors for drug abuse. 4. To develop and promote more effective strategies to prevent people from taking drugs and from progressing to addiction if they do 5. To support research to better understand the spread and risk factors among drug abusing populations. 6. To support participation of all stakeholders in prevention 7. To help in primary and secondary preventions of psychiatric and other medical diseases among drug abusers.
44 28 8. To improve substance and drug abuse prevention and outcomes in drug abusers through a better understanding of processes, risky behaviors and mental problems associated with drug abuse 9. To study and assess the adverse effects of substance abuse and related social, medical, and health consequences within vulnerable populations 10. To enhance methods for campus conduct and policy compliance Objectives of programs show that prevention programs should inform users about availability of prevention activities and policies guiding its use and abuse, educate the users on the causes, course and effect of drug abuse, support the students who are affected by drug abuse at all stages of the drug abuse continuum and maintain activities which promote a good lifestyle without drug abuse. Prevention programs in universities in Kenya need have specific objectives targeting specific outcomes for prevention to be effective. Medina-Mora (2005) acknowledges prevention as any activity designed to avoid substance abuse and reduce its health and social consequences. He argues that effective approaches are required before and after symptoms develop. Prevention is a complementary approach in which services are offered to the general population or to people who are identified as being at risk for a disorder and they receive services with the expectation that the likelihood of a future disorder will be reduced. Prevention seeks to reduce incidence, prevalence, recurrence and time spent with symptoms. Decreasing the impact of illness on the person, family and society are considered part of prevention. Stevens & Smith (2005) contend that once there is a perceived need for prevention, initial
45 29 questions should involve who should be targeted and goals to be set. Substance Abuse Mental Health Service Administration (SAMHSA) and National Institute of Mental Health (NIMH) state that prevention is different from intervention and treatment in that it is aimed at general population groups with various levels of risk for any problem with the goal of reducing risk factors and enhancing protective factors. They further argue that the framework can be used to match interventions to needs of a targeted population. However, it is sometimes confusing to demarcate prevention levels from interventions. Intervention levels refer to the focus for the strategy, whether programs are targeted at community or systems or individuals; interventions refer to the audiences of target. Institute of Medicine (Mrazek & Haggerty, 1994; Ayah, 2011; Kloos, et.al, 2012) categorize as these intervention levels into three types. The first is Universal programs which are programs designed for the general population, such as all students in a university. The mission of universal prevention is to deter the onset of drug abuse by providing all individuals in a population with the information and skills necessary to prevent the problem. Further research on these programs demonstrates that these programs might encourage complete abstinence from drug use (Issel, 2004). The main strategies being employed at this level of intervention is teaching people how to view drugs and the potential impact on their lives (Ray & Ksir, 2002). It also includes building public health policies which create a safe and supportive environment for development of personal skills among students. Persons at elevated risk are less amenable to universal preventions. Hence, despite widespread knowledge dissemination, public relations campaigns and educational programming, a large proportion of the population engages in risky sex, has an unhealthy lifestyle, exercises poor nutrition, uses illegal drugs, as well
46 30 as engages in injury-prone behaviors (e.g. driving without seatbelt fastened). For these individuals, intensive individualized prevention is required to effectively reduce or more hopefully ameliorate the risk. Toward this end, selective and indicated prevention interventions are required. Their objective is to attenuate the likelihood of adverse outcome by directly modifying the factors causing the heightened risk status. An example of universal program is project Adolescent Learning Experiences in Resistance Training (ALERT), which targets alcohol, marijuana and cigarette use and is designed to help students identify and resist pro-drug pressures and understand the social, emotional and physical consequences of harmful substances. It aims to motivate students against using drugs and give them the skills they need to translate that motivation into effective resistance behavior, an approach that is widely viewed as the state of the art in drug-use prevention (Rand, 2004). ALERT is a science-based exemplary model program which addresses substance misuse rather than simply use, because of the widespread acceptance of these substances amongst youth. ALERT and many other school-based drug prevention programs draw on the tenets of social learning theory. Social learning theory focuses on the learning that occurs within a social context, and considers that people learn from one another through observation, imitation and modeling. Basically, social learning theory says that people can learn by observing others behavior and the outcomes of those behaviors; that learning may or may not result in a behavior change; and that cognition plays a role in learning. Accordingly, awareness and expectations of future reinforcements and punishments can have a major effect on the person s behaviors. Selective prevention strategies target subgroups of the general population that are at risk for substance abuse. Numerous risk factors have been identified in youth at risk for the
47 31 development of a variety of adverse outcomes (NIDA, 2003; Cleveland et. al.2008). First is genetic risk factor where a family history of a substance use disorder or psychiatric disorder is associated with increased risk for a disorder in offspring. Research literature shows that paternal substance use disorder or antisocial behavior transmits risk for these disorders in male offspring. Another factor is biological mechanisms of risk which according these authors augment the risk for an adverse outcome in children. For example, children who mature or reach puberty at a young age are at elevated risk. This appears to be caused by their heightened physical appearance of maturity, combined with lack of intellectual and social maturity which puts them at risk through association with older peers who expose them to risky situations. Behavioral risk factors are associated with substance abuse and other outcomes (NIDA, 2003; Cleveland, et. al.2008).temperament, for example, is a well-established risk factor, particularly where the child demonstrates the so-called "difficult temperament". This disposition is featured by high behavioral activity level, difficulty in socializing, low task persistence, high emotionality or irritability, and irregular sleep-wake cycles. Children with difficult temperaments, particularly where extreme, often manifest maladjustment at an early age which sets the trajectory for behavioral problems during childhood and ultimately early age exposure to alcohol and drugs. Along with these dispositional characteristics are impulsivity, sensation seeking, and aggressively. Cognitive Risk Factors influence individual s beliefs about whether to engage in alcohol or drugs or not. Those who believe that these compounds are personally enhancing are more likely to use, and consequently a continued pattern of consumption puts that person
48 32 at risk for developing an addictive disorder. Many misattributions are made by individuals regarding the risk associated with their own behavior. This has been demonstrated by the fact that youth typically underestimate the risk of unprotected sex or not using seatbelts. They also underestimate the risk, or have misattributions, regarding the hazards associated with alcohol or drug use. Neuropsychological processes which refer to the capacity to strategically plan behavior, monitor behavior during goal directed motivation play an important role in determining drug use. It has been shown that youth at high risk for substance use are deficient in executive cognitive functions. Low executive cognitive capacity is also associated with high aggressiveness. As a result of this reduced capacity, high risk youth lack the ability to preview their behavior, or exhibit foresight with the same capability as normal youth. These neurobehavioral factors contribute to the risk for substance use in youth which are manifest especially in the form of lower executive cognitive functions. Prevention programs have a task of considering all the factors that expose university students to risks. However, some of these risk factors can be identified using psychological tests. This could present another challenge for those prevention programs that are not adequately prepared with tools for psychological testing. Apparently, this is a requirement that would enhance the effectiveness of prevention programs at all intervention levels. Indicated prevention interventions identify individuals who are experiencing signs of substance abuse and other related problem behaviors associated with substance abuse and target them with special programs. These programs are even more extensive, longer and
49 33 are effective in preventing the developmental progression from one disorder to another. They require greater effort on the part of participants than do selective or universal programs. Programs require highly skilled staffs that have clinical training, counseling and other skills. In the field of substance abuse, an indicated prevention intervention would be a substance abuse program for students who are experiencing a number of problem behaviors, including truancy, failing academic grades, juvenile depression, suicidal ideation, and early signs of substance abuse. Examples of indicated programs are Project Towards No Drug Abuse (TND) and Reconnecting Youth Program (RY) whose main activities entail equipping youth with skills to defy drug abusing activities. They are also trained to value their personal development. Levels of prevention refer to the stage at which drug abuse problem is addressed. It indicates whether the problem is handled before it starts, as it develops, or after it has developed as a problem. The Public Health Model identifies three levels of prevention programs as Primary, Secondary and Tertiary prevention. Primary prevention refers to programs aimed mainly at young people who have not tried substances and drugs. These programs presuppose an adequate knowledge of causal mechanisms and calls for development of procedures capable of influencing them at an early stage (Perkins, Haines & Rice (2005). Primary prevention programs would be helpful to university students in avoiding initial use of drugs amongst students who have not started using them. Studies demonstrate an increasing rate of drug abuse with the year of study (West, 2006).It is thus necessary to equip college freshmen who have a lot of free time and high social interactions with information on how to avoid drug using behaviors to equip them with protecting strategies.
50 34 Secondary prevention entails programs designed for people who have tried drugs. These programs are thus aimed at stopping development of drug use into addiction. This category of prevention is equivalent to selective programs which target groups at risk or subsets of the general population, such as poor school achievers or children of drug abusers according to Institute of Medicine (Mrazek & Haggerty, 1994). Prevention Programs need carry out early screening to identify those who fall under addiction dispositions. At the university, a sizable number of students fall into this stage of drug use and effective prevention programs should be able to identify and place students falling in different categories in order to reduce the degree of individual and social damage (Ghodse, 2005). The third level of prevention is Tertiary prevention which corresponds with indicated programs according to prevention classification of Institute of Medicine. It helps people to manage health problems that have long term consequences such as addiction and relapse to drug use (Ray & Ksir, 2002). Activities which may be included at this stage are follow up programs such as Inpatient and Outpatient programs, Alcoholics Anonymous (AA), Narcotics Anonymous (NA) and After Care Services. Rehabilitation services which provide emotional support as well as psychotherapy towards psychological change along with growth of the individual s self-actualization also fall in this category of prevention. University setting encompasses students who are already addicted to drugs and they require help in order to obtain sobriety hence tertiary prevention programs would be effective in meeting the needs of this group of university community. Table 2.1 provides description of Prevention and Intervention levels.
51 35 Table 2.1 Prevention levels and interventions Prevention Level Intervention Level Target of Prevention activities Primary Universal Targeting the general public or whole population or group before the problem starts Secondary selective Target sub-groups of the population whose risk of developing the disorder is higher than average when the problem has already started but has not progressed to addiction Tertiary Indicated Targeting high-risk individuals whose drug problems are in addiction or relapse University population composes of students and staff with substance abuse psychosocial facets in all the above categorical levels of prevention and interventions. Prevention programs which are comprehensive in availing appropriate programs to diverse university community groups stand better chances of effectiveness. Medina Mora, (2005) supports this strategy that in the past, there was a tendency to regard primary prevention as the only true form of prevention but effective prevention approaches are required before and after symptoms become apparent. In his view, prevention of recurrence and relapse, including relapse after successful treatment is an essential aspect of a public health strategy to reduce prevalence. In this case, programs that comprehensively deal with all levels of prevention are effective in addressing drug abuse cases falling in the drug addiction continuum, a phenomenon present amongst university students. Galanter & Kleber, (2008) in concurrence of this fact discuss on third taxonomy of prevention which involves downstream interventions in which focus is on the individual and his or her
52 36 lifestyle or behavior. According to them, Midstream intervention in which the focus is on the communities and upstream interventions involving policies that support prevention are all important in prevention strategies (Mc Kinlay & Marceau, 2000). The discussion on the concept of prevention suggests that, all forms of prevention practice must necessarily involve the conjoint application of universal, selected and indicated interventions as well as primary, secondary and tertiary prevention levels. As a nifty gritty procedure, two significant steps should be taken. First is about the social contexts in which those individual students live and stay in campus and at home within the community ought to be considered during planning of prevention programs if effectiveness is to be realized. Secondly, prevention interventions must consider the developmental stage of the individual in gauging the extent to which the person is at elevated risk. This provides the opportunity to project the child s future developmental trajectory. The premise behind all prevention is that the direction of the developmental trajectory can be re-oriented to positive outcomes following the implementation of an effective intervention (Trudeau, et. al.2003). Research demonstrates (NIDA 2009, The Mentor Foundation, Schinke, Brounstein & Stephen, 2002) that any successful prevention program ought to be guided by principles. Dusenbury & Falco (1995) conducted a literature review of research on substance abuse prevention programs and interviewed 15 experts in prevention research to determine the components of effective drug abuse prevention programs. This resulted in identification of 11 key components deemed essential principles for prevention programs as follows;
53 37 1. They should be research-based and theory-driven. Curricula should be based on research and supported by rigorous theoretical underpinnings that address both the risk and protective factors associated with substance use. 2. They should possess developmentally appropriate information. The programs should provide accurate and developmentally appropriate information that focuses on the current reality for children. Information that exaggerates the consequences of substance use or highlights risks that may affect children in the future are less likely to be effective. 3. Social resistance skills training need to be included. Programs should help students identify and resist the social pressures to use drugs that they are likely to encounter. 4. Normative education is part of prevention. These programs should help students understand that most people do not use drugs and that substance abuse is not a normative behavior. 5. Should include broader-based skills training and comprehensive health education. Programs should help students develop strong decision-making skills, goal-setting abilities, stress management techniques, communication skills, social skills, and assertive skills so that they can make and defend their sobriety decisions. 6. Interactive teaching techniques are important. Programs should be based, at least in part, on interactive teaching techniques (such as role-playing or small-group activities). 7. Teacher training and support is a necessary part. Because these programs should be interactive, teachers need to be trained in interactive teaching techniques. Success of
54 38 prevention programs is based on the ability of participants to adequately implement the components of the program. Riggs (2003) supports this point emphasizing focus on adequate training and ongoing staff development activities for counselors and program specialists. 8. Should have adequate coverage and sufficient follow-up. To help mitigate the tendency of program effects to decay over time, interventions should be sustained and offered periodically. 9. Cultural Sensitivity needs considered. Because of the focus on social resistance and normative behaviors, prevention programs should be culturally relevant to the participants. 10. Additional components should be incorporated. Within a prevention program, family, community, and media components that support the goals of reduced substance use can add additional support for students. 11. Evaluation is an important component. An independent evaluator should assess these programs for effectiveness. Many programs have been rigorously evaluated. Decision makers should request such information before they adopt a curriculum or program. Riggs (2003) supports this fact that systematic evaluation to identify problems and treatment needs in multiple domains including psychiatric co morbidity is important. Precepts from the above principles generate paramount prototypes of ideals for effectiveness in drug abuse prevention which universities in Kenya could model.
55 Drug and Substance Abuse Prevention Programs in Universities Drug and Substance Abuse Prevention Programs in the US Universities The US launched the Higher Education Center for Alcohol and other drug abuse and violence prevention to help campuses and communities develop strategies for changing campus culture; foster environments that promote healthy lifestyles and prevent high risk alcohol and other drug use and violence among students. This center has encouraged Colleges and universities to initiate a number of activities which are aimed at helping students successfully transition into campus life and at reducing a range of problems related to student drinking. In universities where programs have been established, drug abuse cases and consequences associated with it have lessened. Criteria used by US department of Education (NIDA, 2008) on award-winning prevention programs have helped identify some of the campuses whose prevention programs have demonstrated effectiveness. Examination of these programs would be important for benchmarking in Kenyan universities. Vicary & Karshin, (2002) observed that Social marketing campaigns are popular interventions in reducing binge drinking in US universities and seems to have some effectiveness in influencing students beliefs and behavior towards drug abuse. Western Washington University has incorporated several programs such as Social Marketing Campaign, Health Opinion Leaders, and Community-Health Service Learning Program. It would help universities in Kenya if students are engaged in campaigning against drug abuse so that they may persuade their colleagues who may otherwise be using drugs.
56 40 At the Auburn University, the program being used is Brief Alcohol Screening and Intervention for College Students (BASICS) founded in It is a supportive program to enhance motivation and make students learn how they might benefit from not engaging in drug abusing behaviors. This has reduced enthusiasm among some students to avoid taking drugs. However, this needs to be applied in Kenyan Universities with caution through amiable approaches to avoid misinterpretation that they are being compelled and for students to see the beneficial effect it has on them. University of Boston employs a comprehensive community-based program involving encouragement and law enforcement on drug abuse prevention. This is done through a Task Force which ensures students make healthy decisions and exercise a sense of responsibility with use of drugs. Feedback on what students think about alcohol is through e-checkup which enables students to develop self-awareness on their drug status. Other programs in this university include e-toke, CHOICES and BASICS (Retrieved from An enhanced involvement of students is likely to contribute to effectiveness hence these programs offer a good example to universities in Kenya Prevention program at Bowling Green State University is called Bowling Green State University Peer-Based Alcohol prevention. It targets misperceptions, attitudes and behaviors that discourage drug abuse. It was based on study findings that perceived drinking norms and the actual norms do not tally therefore the programs were established to address this gap. The Program at Rutgers University applies a similar strategy of targeting misperceptions though their RU SURE program which encourages students to
57 41 review their behaviors (D Amico & Edelen (2007). This is a strategy geared towards introspection which ideal for encouraging individual ownership of prevention amongst students. Based on the theoretical framework highlights above, these programs have strong lessons to offer Kenyan universities on the crucial role individual initiative plays in comprehending accurate norms to be encouraged in the university. At the university of Virginia, a student body called Alcohol and Drug Abuse Prevention Team (ADAPT) promotes awareness, provides educational outreach, and serves as accessible resources for their fellow students. These are meant to encourage the students, faculty and staff involvement in environmental change and community collaboration. Tarter (2006) reiterates the significance of these practices that intensive individualized prevention is required to effectively reduce or more expectantly ameliorate the risk of abuse. Social marketing has shown great promise in addressing a wide range of problems including adolescent substance abuse (Denniston, 2004 in Coreil, 2010). In general, multiple-component programs which include school, family and community prove to be the most effective. Kenyan universities require family involvement in prevention activities to ensure complementarity of efforts and whole roundedness of drug source. At Berkshire Community College, a program called Leadership in education about alcohol and drugs (LEAD) operates a range of activities mainly to create positive reinforcement and Peer leadership, with emphasis on civic and individual values and responsibilities. The programs assess the environment and contribute to written policies and procedures for the college community; promote education, prevention, and intervention efforts that include curriculum adaptations, student-peer participation, staff
58 42 orientation, and training; and provide activities to motivate students and generate positive publicity. These programs are supported as good approaches to drug treatment due to their ability to address certain aspects of drug addiction and its consequences for the individual, family and society (Medina-Mora, 2005, NIDA, 2009). Health Entrepreneurship is a program started at the Montana State University to redefine drug and alcohol norms on campus through the development of autonomous "microbusinesses" that focuses on health. Thus, the role of the Health Promotion staff becomes that of health entrepreneurs who teach students to apply environmental strategies into their daily operations. A similar program is in George Mason University where transformation of campus cultures is done through healthy expectations program which promotes positive expectations, norms, skills and proactive life healthy planning. The healthy life planning is founded on seven principles namely; optimism, values, self- care, relationships, community, nature and service. These principles have been integrated in an initiative dubbed COMPASS which handles topics appropriate for healthy life planning on many aspects of life. They are distributed to first year students so that a culture of healthy living may be established. Retrieved from Attesting to these practices, (NIDA, 2003; Ghodse, 2005) argue that if prevention programs are incorporated into a wider perspective of healthy lifestyles rather than emphasizing what is forbidden or dangerous, they become more effective. COMPASS program spreads tentacles of dissemination on drug abuse so that students may view from the perspective of health benefits. This program sets a good example which can be
59 43 embraced by university students without necessarily feeling being coerced into not using substances. It could lead to prevention effectiveness if implemented. At the University of Scranton, The Drug and Alcohol Information Center and Educators (D.I.C.E) is a program geared towards encouraging students to consume alcohol in legal, low-risk ways, and in ways which abstinence from the use of drugs and alcohol is acceptable. Students are encouraged to make informed decisions supporting responsible alcohol use and make it a habit to participate in organized activities emphasizing responsible use of alcohol and non-use of illegal drugs. In support of these programs (Dusenbury & Falco, 1995; Botvin, 2005) contend that Life Skills Training is the most effective and rigorously tested school-based prevention program which has been proven to cut alcohol, tobacco and drug use by up to 87 percent. They recommend programs which help students develop strong decision-making skills, goal-setting abilities, stress management techniques, communication skills, social skills, and assertive skills so that they can make and defend their sobriety decisions. These skills enhance student efficacy in drug abuse prevention which has demonstrated its crucial significance for effective implementation. On examining these programs, one realizes that most universities have established programs based on research findings (Deas, et.al. 2000; Winters et al.2007) who argue that, behavioral and psychosocial interventions can be effective in treating adolescent drug abuse and other associated problems. On the same note, (Riggs, 2003, Barry, 2003; Epstein & Mc Crady, 2009) postulate that, cognitive-behavioral and behavioral therapy approaches are based on operant behavioral principles such as, rewarding behaviors
60 44 because they provide a constructive reinforcement system for the students. Social learning-based drug prevention programs have positive long-term effects on tobacco, alcohol, and marijuana use (Botvin & Griffin, 2007; Teesson, Newton & Barrett, 2012). Additionally, programs mentioned above produce similar improvements in substancerelated behavior, such as reductions in antisocial behavior and school behavior problems, and in areas of social functioning, such as improvements in academic skills, greater commitment to school, improved drug refusal skills, and reduced affiliation with deviant peers (Riggs, 2003, Barry, 2003; Epstein & Mc Crady, 2009). Student psychosocial operations may influence their responsiveness to prevention programs and judicious effectiveness. Target areas for prevention programs are on development of individual skills to protect from being influenced to using drugs. These include; decision-making skills, sports nutrition knowledge, perception of personal athletic competence, athletic self-efficacy, exercise skills, reasons for not using drugs, proper nutrition and eating behaviors, perception of drug risks, knowledge about steroids, alcohol, and other substances of abuse. Peers are also prepared to offer correct information about drugs. Protective factors should be enhanced in the school as well in order to coaching staff intolerance to substance use. Brief alcohol and screening Intervention for colleges students combines both selective and indicated levels of prevention to reduce on the problem of alcoholism is conducted over the course of only two interviews, and these brief, limited interventions prompt students to change their drinking patterns. Through this program, post-intervention
61 45 students often comment that they respond differently to friends as a result of participation (Hanson, 2013). Prevention strategies at the university of Albany has made use of a program called STEPS which focuses on University comprehensive Screening and Brief Intervention (SBI) strategy based on the Brief Alcohol Screening and Intervention for College Students (BASICS) of years of age. The intervention is aimed at students who drink alcohol heavily and have experienced or are at risk for alcohol-related negative consequences. The STEPS model is designed to reduce alcohol use, frequency and quantity. Secondly is to reduce associated negative consequences by adapting interventions to meet the distinct and complex needs of the three target populations of high-risk drinkers namely, first-year students, student-athletes, and students seeking primary health and mental health care on campus. This demonstrates that effective programs need to have all the three levels of prevention. A universal program founded by Botvin & Griffin (2007) is an evidence-based prevention program which concentrates on a variety of risk and protective factors to teach personal and social skills. It is designed to impart to students the necessary skills to resist social pressures to smoke, drink and use drugs and improve cognitive and behavioral competence and to prevent a variety of health risk behaviors. A study by (NIDA, 2003) found that Life Skills Training (LST), a thoroughly tested, school-based, universal prevention program, significantly reduced initiation of drug use among urban, minority middle school students who were doing poorly academically and had substanceabusing friends. Previous research has linked these academic and social factors to
62 46 increased risk of subsequent substance abuse. Yet one year after the LST program, these high-risk youths reported lower rates of cigarette, alcohol, and inhalant use than a comparable group of nonparticipating students. Moreover, LST participants who reported using these substances used them in lower amounts than nonparticipants. Resistance skills programs as a whole have generally been successful. Botvin (2000) states that a comprehensive review of resistance skills studies published from 1980 to 1990 reported that the majority of prevention studies (63%) had positive effects on drug use behavior, with fewer studies having neutral (26%) or negative effects on behavior (11%) with several in the neutral category having inadequate statistical power to detect program effects. Furthermore, several follow-up studies of resistance skills interventions have reported positive behavioral effects lasting for up to three years, although longer term follow-up studies have shown that these effects gradually decay over time, suggesting the need for ongoing intervention or booster sessions. Mihalic, Fagan, & Argamaso, (2008) in their appraisal of this program argue that although most sites faced common barriers, such as finding room in the school schedule for the program, gaining full support from key participants, ensuring teacher participation in training workshops, and classroom management difficulties, most schools involved in the project implemented LST with very high levels of fidelity. Life Skills Training should be promoted amongst students to teach them resistance techniques. Evaluation studies of DARE by Dennis Rosenbaum and Gordon Hanson examined the most scientifically rigorous published evaluations of DARE and concluded that DARE has little or no impact on drug use behavior, particularly beyond the initial posttest
63 47 assessment. Some of the possible reasons why DARE is ineffective may be that the program is targeting the wrong mediating processes, that the instructional methods are less interactive than more successful prevention programs, and that teenagers may simply "tune out" what may be perceived as an expected message from an ultimate authority. This raises a cautionary note to Universities in Kenya to dissuade programs which may appear fanciful but may not appeal to users as evidenced by Botvin & Griffin (2005) who argue that the etiology of drug and alcohol abuse is complex and prevention strategies that rely primarily on information dissemination are not effective in changing behavior Drug and Substance Abuse Prevention Programs in European Universities In the UK, colleges are using a variety of methods to educate students around drugs and to challenge their perceptions and attitudes (Polymerou, 2007) and is organized and delivered in a wide health promotion network (Dunne & Summerset, 2004). McCambridge & Strang (2004) examined ten education colleges across inner London and observed that students that received the Motivational Interviewing intervention reduced the use of alcohol, cannabis, other drugs and cigarettes at three months follow up compared to students who received education as usual. Miller and others (NIDA, 2003; Miller at al., 2005) reported that older youth at university or entering the working world often continue a pattern of heavy substance use begun in secondary school. Their reported use of substances to cope with pressure is a concern, as is using to the point of intoxication and thereby risking accidents or, particularly in the case of alcohol, violence. Motivational and skills-training approaches are proving effective in reducing substance use problems in university settings.
64 48 Another most well-known campaign in London was 'Study Safely'. This campaign was targeted at further and higher education students aged over 18 across London and was run jointly by 26 London Drug Action Teams (DATs). It was based on a non-judgmental, harm-minimization strategy. The materials produced were received very positively and the National Union of Students (NUS) encouraged their Alcohol and Drug Prevention in Colleges and Universities making a positive impact (Branigan & Wellings, 1998). The role of students active participation and dissemination of information on drug abuse prevention enhances effectiveness as they embrace drug abuse prevention programs. Social norms interventions are strategies targeting students misperceptions about drug abuse and its consequences. Research demonstrates that students don t accurately perceive the nature and use of alcohol and drugs amongst their peers (Hollands & Myer, 2006). Polymerou (2007) reports effectiveness of extracurricular activities as part of drug abuse prevention programs for adolescents (Stigler et al., 2006) and the findings about the role of extracurricular substance free activities among college and university students (Murphy et al., 2005) have potential implications for prevention programs in universities and colleges. Adolescents that participate in extracurricular activities such as pro-social activities, team sports and performing arts have better academic performance and college attendance as well as a lower risk of dropping out. Participation also predicts reduced involvement of risk taking behaviors, including alcohol and drugs and better self-esteem (Eccles et al., 2003). Different types of activities are related with different types of outcomes. For example, prosocial and performance activities predict lower increase in
65 49 alcohol use while participation in sports has produced mixed results in youth substance use (Fredricks & Eccles, 2006; Eccles et al., 2003). Additional support for the role of sport in drug prevention comes from the Positive Future Programme, a social inclusion programmer in England that engages young people in sport activities. There is evidence that the programme may have a positive influence on participants substance misuse, physical activity and offending behavior (Eccles et al., 2003).Beneficial role of extracurricular activities in students attending university is supported by research that shows the important reinforcing role that student activities have on reducing drinking in the campus. Murphy et al. (2005) found that students who decreased their drinking showed increased reinforcement from substance free activities. The FRANK campaign is a partnership program amongst department of Health and education units in the UK which provides information on drug abuse risks as an endeavor to discourage young people from engaging in drug taking behaviors. It has helped in reducing drug abuse cases amongst young people. Retrieved from (http://www.talktofrank.com/ In Germany, a program called Information and Psychosocial Competence (IPSY) established by psychologists and psychiatrists in the university of Jena teaches students life skills making them less susceptible to peer pressure and drug abuse habits, (Weichold, 2011) This is supported by a study conducted earlier by the Global Youth Network that positive peer pressure should be encouraged through art, music and sports in order to encourage self-esteem and self-confidence (UN 2002). In Romania, a program called our Measure Your Lifestyle encourages students to enjoy alcohol in moderation
66 50 and so avoid personal, social and health costs to themselves, their families and society as a whole (Retrieved from of personal values can be an effective strategy to preventing drug abuse amongst university students since art and sporting activities are popular Drug and Substance Abuse Prevention Programs in Asian Universities A study done in the University of Wuhan in China suggests that prevention places attention among young internet users, Jenaro, et.al (2007). Shakeshaft,et.al. (2005) reported that, educating students about the dangers of drug intake as well as its moral and religious implications is likely to be more effective than increased policing. They further emphasize integration of addiction medicine into the undergraduate medical curriculum. Integration of addiction medicine in the university curriculum has been more effective in reaching out to students. Social Media such as Tweeter and Face Book could be used to communicate ADA messages to students as they communicate amongst themselves. In the Philippines, the Youth Life Enrichment Program (YLEP) was implemented in the college level through the psychological societies of the different colleges and universities in Metro Manila (Cornelio, Banaag, & Jesus, 2000). The program is committed to providing education and advocacy activities on drug abuse prevention among the youth. These programs have contributed to drug abuse reduction. At the Philippine Women s University, The University s Drug Prevention, Recovery and Post-Recovery Care Program consists of three components of prevention, recovery and post-recovery care which all aim at helping students not to abuse drugs. At Trinity University of Asia, a project called HEALS encourages student volunteers and community clients to observe wellness and busy themselves with worthwhile social activities or services to prevent
67 51 them from engaging in drug and substance abuse (Ebuen, 2008). These projects have helped students participate in preventing drug abuse amongst their colleagues through dissemination of information and an inclination to prevent drug abuse. Participation of students in positive various activities makes them meaningfully occupy their time and plays a big role in making prevention programs effective. A study carried out in Japanese universities indicated that substance abuse prevention programs for college students address the health effects of risky drinking behaviors and train students on how to avoid submission to peer pressure, (Shimane et al., 2009). In Australia, response to the drug problem is an integrated approach, involving law enforcement, health, prevention, education and treatment services. In universities, Peer educator program, Youth sport and recreation program play an important role in prevention. From a law enforcement perspective, the focus is on prevention and partnerships with colleagues nationally and internationally (Lockwood & Saunders, 1991). Strengthening policy implementation is an important value addition to prevention programs effectiveness Drug and Substance Abuse Prevention Programs in African Universities Most of the prevention programs in African Universities entail those offered by Non- Governmental and Governmental organizations whose fundamental objective is to empower students on prevention of substance abuse. Drug control strategy in the sub region of West Africa hinges on a combination of supply control and demand reduction programs (Adelekan, 1996). Through these programs, dissemination on drug abuse causes, course and effects has been done to enable students acquire appropriate information necessary for effective prevention of drug abuse.
68 52 Burnhams, Myers, & Parry, (2009) in their study in learning institutions in South Africa reported that Prevention programs in Cape Town mostly take the form of educational programs (91%) which aim to raise awareness by providing knowledge about drug abuse and their consequences. It encompasses Comprehensive survey of substance abuse to identify those with the most serious drug and alcohol problems in order to offer psychosocial support, over and above awareness and education, (McDonald, 2010). Another program established under the partnerships of students, university authority and Miller Company used three educational channels consisting of poster positioned on campus pubs, banners with taxi information displayed during orientation week events encouraging drinkers not to drive drunk and disposable breathalyzers carrying a responsible message given out at various events. The Global Initiative on Primary Prevention of Substance Abuse by World Health Organization and United Nations on Drug and Crime (2003) initiated comprehensive substance abuse prevention programs involving various projects in South Africa, Zambia and Bagamoyo, Tanzania for young people in schools and universities. Activities include broad-based interventions that give equal weight to supply and demand reduction; improve young people s living conditions; and ensure that community agencies are mobilized towards preventive action. Comprehensiveness of prevention programs to include individual and environmental related approach is significant in adequately addressing drug and substance abuse. In Namibia, The Suzie and Shafa Show is a lifestyle s variety show created by youth for youth between the ages of 15 and 24. The radio program airs on the University of
69 53 Namibia (UNAM) Radio 97.4 FM. The programs address different types of lifestyle issues youth face, including; alcohol and drug abuse, dating, date rape, staying healthy and avoiding and preventing sexually transmitted infections (STIs), and HIV infection. A radio program that accurately targets youth oriented activities would be a strong avenue through which drug abuse information is effectively passed to them Substance Abuse Prevention programs in Kenyan Universities The Ministry of Education in Kenya (GoK, 2003) mandated universities in the performance contracting to initiate drug abuse prevention. This resulted in universities networking and linkages with the Ministry of Education, Science and Technology, and NACADA (Hagembe, & Simiyu, 2006). Through this, surveys, dissemination of information and training of trainer of trainers (TOTs) on drug abuse has been carried out. These are important processes that unveil pillar themes to target in order to upgrade drug abuse prevention effectiveness. At Kenyatta University, Kamanja, (2010) reports that the peer education program aims to reduce irresponsible sexual behavior, unwanted pregnancies, sexually transmitted infections (STIs) including HIV/AIDS and drug abuse by enhancing the quality of counseling and service delivery for students. He says that peer outreach and extension program trains university students to promote responsible behavior among their peers. Through peer counseling program, students obtain information on drugs and referrals for better help from trained counselors are done for students with complicated drug abuse cases. Other drug abuse prevention programs are done through dissemination of information about the onset, course, effects and intervention approaches to drug abuse through University Newsletter and radio station (99.9 FM). Student clubs such as
70 54 Kenyatta University Youth Against Drug Abuse (KUYADA) spearhead drug abuse prevention activities through talk shows, (Oral interview, 2010). This student body caries out dissemination activities amongst the students. Participation of many student bodies in prevention promotes effectiveness through positive student responsiveness. At The University of Nairobi, a program called Students Campaign Against Drugs (SCAD) discourage students from using drugs in the campus. Peer counselor program has been active through the assistance of Pathfinder International. A survey carried out by Ndetei (2001) established that Nairobi University Association for a drug- free society (NUADS) had done some advocacy work and was planning to extend it through cooperation with students in other Kenyan public and private universities. Through these student organizations, networking links within and outside the university has been made possible hence improving effectiveness through diversification of approaches to prevention. At Jomo Kenyatta University of Agriculture, REPACTED in collaboration with other Nongovernmental organizations such as, the MTV Staying Alive Foundation, the Raising Global Voices Online, the Nakuru Players Theatre, APHIA II Rift Valley, Partners for Progress, Act Alive, Vices of Roses, National Organization of Peer Educators, Kenya and the National AIDS Control Council provide information on drug abuse causes and prevention. Retrieved from approach amongst university service providers and outside agencies to drug and substance abuse prevention could enhance effectiveness due to joint material, human and financial resources.
71 55 Daystar University was one of the first universities to involve NACADA in their drug and substance abuse prevention campaigns against smoking, gambling, use of intoxicating liquor, use of illegal drugs, and use of obscene or pornographic materials in September 2005 leading to declaration of Daystar University as a drug abuse free institution in February 2006, (Retrieved, June 13, 2010 from /partnerships). Kenya Methodist university prevention programs are implemented through Kenya Methodist University Campaign Against Drug Abuse (KEMUCADA). It disseminates information on the effects of drug abuse amongst students and staff. It also carries out campaigns against drug abuse in the neighboring communities of the campus to counteract drug abuse. From the above literature review on universities of the world, Africa and Kenya, it becomes patently clear that various universities apply diverse approaches depending on their contextual orientation. However, models shown to be predominant in drug abuse prevention practice include; Awareness model, Attitude change model, Social influences model and the most recent and seemingly preferred, Ecological model. Hansen, Dusenbery, Bishop & Dersen (2007) further clarify this in their summary of seven distinguishable approaches including; changing access within the environment, promoting the development of personal and social skills, promoting positive affiliation, addressing social influences, providing social support and helping participants develop goals and alternatives, developing positive schools and enhancing motivation to avoid substance use. The emphasis is that programs operate by changing characteristics of the individual, the social group or the social or physical environment that subsequently influence behavior. Their findings too suggested that program developers borrow across
72 56 theories to construct effective prevention programs. Stevens& Smith (2005) advocate a comprehensive approach which has the following characteristics; multiple levels of intervention and populations multiple strategies, networks of resources sensitivity to development and diversity factors, multiple effects and consequences of substance use and abuse and need for long term effort. Botvin and Griffin (2005) classify prevention approaches into five categories, namely information dissemination, affective education approaches, alternatives approaches, social resistance skills approaches and competency enhancement approaches. These approaches have been shown to work in various universities and are in line with the theoretical framework of the study vividly pointing to ardent consideration of factors surrounding the individual and the environment they live in Summary of the Literature Review The literature review reveals that understanding major principles which govern the practice of prevention and need for all levels and interventions is crucial as delineated clearly (Ries, Fielin, Miler& Saitz (2009). Objectives of most programs aim to disseminate information on causes, course and effects of drug abuse while promoting a healthy lifestyle. Other objectives target the source of drugs in the campus and how they are permeated into the student population. Universities in Kenya aim at reducing drug abuse and creating a drug free culture. The main principles portrayed in the literature review includes: involvement of all stakeholders, carrying out research to identify viable programs, engaging all levels of prevention and enhance protective factors and reduce
73 57 risk factors. It also showed that prevention programs can be effective when they employ interactive techniques and active participation. Universities in the US and the make use of approaches such as life Skills, social marketing, screening, e-communication, student involvement, peer-based programs, involvement of all stakeholders, establishment of drug free culture, resistance skills and behavioral and psychosocial interventions. Other main approaches and activities include; motivational interviewing and skills training, student involvement, dissemination of information, prosocial skills, sporting activities, and personal values. In Asian universities, approaches include but are not limited to targeting internet users, integration of prevention programs into the formal program of the university, education and advocacy, student involvement, peer-education and sporting and recreational activities. In the African continent, use of empowerment and sensitization of information, surveys to identify those who require a specialized attention, supply and demand reduction strategies, mobilization of community agencies and dissemination of information to every member of the university community. Universities in Kenya employ dissemination of information, training of Peer counselors, declarations of the university premise as a drug free zone as the main strategies. Counseling department and other social support providers such as chaplains were depicted as the main implementers of prevention. However, many organizations dealing with prevention and research prevention were also shown to be taking an active role in prevention. Examples include, NIDA, Mentor Foundation and Narconon International. Student participation and utilization of prevention programs was enhanced when
74 58 programs were administered formally to a selected group of students under clear supervision by program implementers. Literature showed that universities face challenges of implementation and lack of support from some stakeholders. Overwhelming student socialization places a stiff completion between sustaining a healthy lifestyle and using drugs to binge levels. It also showed that being able to identify programs which work well required time to test before implementing. For instance, some of the programs like DARE were shown to be effective but not many universities had applied them. Lack of adequate time and resources were other limitations which were faced by prevention programs. The literature revealed that developmental and intellectual levels of the users should be targeted so that activities may be geared at addressing drug abuse issues which are applicable to the various categories of students. In summary hence, the literature review of this study demonstrates that, there is no single approach that has been found to work similarly in all populations and environments. Perhaps a combination of a variety of methods, strategies and models may work effectively. However, fundamental principles of implementation must be laid down for any prevention program to succeed. It is on this premise that this study found it most fitting to assess effectiveness of substance abuse prevention programs in selected Public and Private universities in Kenya. 2.4 Conceptual framework Literature review in this study illuminates effective prevention programs as those with multimodal approach not withstanding environmental variance. Such programs put into
75 59 consideration factors such as: developmental appropriateness (Galanter & Kleber,2008), interactive nature of prevention programs and the users, socio-cultural relevance, theorydriven tenets, targets to personal and group values and norms, targets to risk and protective factors, contact with consumer population, enhancement of positive relationships amongst providers and users, self-efficacy and varying methods of service delivery. These variables have an intense influence on prevention programs effectiveness positively or negatively in several ways based on the context of application. This study assumed that these factors should be found integrated in any prevention if it has to be effective. Other parameters which indicate effectiveness if well-structured and harmonized in any prevention activity or program are; Objectives of various levels of prevention programs, methods of service delivery, accessibility of prevention programs to users, synchronization of prevention programs to other university programs, keenness of programs to target developmental stages of users, student participation and utilization of prevention activities, challenges facing DSAPP and target of factors which sustain drug abuse in the university. Whereas Prevention programs and can formulate activities thoroughly, success to implement them relies on the support the university provides in terms of policies, resources, curriculum flexibility and selectivity of student entertainment joints. Outside agencies have a crucial role to play in enhancing effectiveness through partnerships and collaborations for financial and material support. Figure 2.1 demonstrates that interaction between social support providers with the university management for consultation and provision while putting into consideration multimodal approaches in prevention. The critical elements which DSAPP have to give
76 60 articulate attention are parameters which run through a prevention program to ensure that all the elements of a prevention program are captured. Conceptual Framework of the study Social Support Service Providers: Counseling Chaplaincy Mentoring Peer counseling Student Organizations/Groups Security Department Outside groups Multimodal: Psychosocial, Behavioral and Environmental factors: Developmentally appropriate Interactive nature Socio-culturally relevant Theory-driven Target personal and group values and norms Target risk and protective factors Contact with consumer population Enhance positive relationships Promotes self-efficacy Varying methods of delivery Role of University Management: Policies and structures on DSA Financial support Cultural dynamism Status of resources Academic schedules Outside Agencies Effectiveness Parameters: Objectives Levels of prevention and activities Principles of effective prevention programs Resources: Material and Personnel Interdepartmental coordination Communication modes Student Participation and utilization DSAAP target on sustaining factors Challenges facing DSAPP Effectiveness Figure 2.1: Conceptual Framework Source: Researcher, Kemei C. Ronoh, 2011
77 61 CHAPTER THREE RESEARCH METHODOLOGY 3.0 Introduction This chapter provides methodological procedures explaining how assessment of effectiveness of substance abuse prevention programs in selected Public and Private Universities in Kenya was carried out. It includes description of the research design, the target population, sample and sampling procedures, research instruments, data collection and analysis procedures and data management ethical standards each with factors validating their utility choice in this study. 3.1 Research design It was a cross-sectional survey design which utilized both qualitative and quantitative techniques with more emphasis on qualitative approach. This research design was found appropriate to realizing epistemological, theoretical and methodological way of working to serve research purpose (Saldana, 2011). It was cross-sectional involving students from third year to fourth year because first and second year students were omitted due to their short duration at the university. It also involved social support providers in various ranks such as wardens, counselors, chaplains and students in the general population and student leaders. 3.2 Variables This study assessed effectiveness of prevention programs by operationalizing parameters deemed necessary to identify effectiveness namely; objectives of various levels of prevention programs, methods of service delivery, availability of human and material
78 62 resources, synchronization and coordination of prevention programs into other university programs, suitability of prevention programs to users psychosocial and socio-cultural attributes, efficient accessibility of programs to users, student responsiveness, apt response to challenges encountered by the programs and factors sustaining drug abuse in the university. This research also plunked into consideration of confounding variables such as university support, partnership with outside agencies and cultural dynamism. The assumption was that prevention programs that enjoy strong support by the university seem to perform more effectively whereas partnerships with outside agencies may create easy accessibility to financial and material support. Cultural dynamism does not take the same pace in all universities and has great influence on psychosocial factors for prevention. These factors constituted fundamental areas which qualified for meticulous attention during assessment of effectiveness of drug and substance abuse prevention programs in universities. 3.3 Site of study This study was carried out in two public and two private universities. The first university coded PUU1 is the oldest established in 1970 and is situated near Nairobi city with diverse intersectional influences from urban dynamics. The second public university coded in this study PUU2, founded in 2007 and situated in a setting far from major towns and cities was thought to might have much lesser urban influences. The two private universities; coded PRU1 which was started in 1982 and PRU2 started in 2002 respectively are chosen because of their geographical situation and the period of establishment with the same reasons as the two public universities. Apart from the above variations in these four universities, there are other differences in regard to population
79 63 size, quality of available resources and social value systems which have a variation in public and private universities. All these factors were thought to have significant effect on operations and effectiveness of substance abuse prevention programs. 3.4 Target Population. The target population was undergraduate university students in third and fourth year in selected Public and Private Universities in Kenya. 3.5 Sample size and sampling techniques The first multistage sampling entailed cluster sampling to categorize Public and Private Universities. The second stage was purposeful sampling techniques to enable selection of 2 universities from 7 public universities and 2 universities from about 24 private Kenyan universities at the time of study. This study choose two in each category to enable comparison due to variability in value system, management approaches and availability of resources all of which, influence prevention programs effectiveness. The third stage was a random selection of the main respondents from each university and purposeful sampling to identify 104 Social Support Service Providers composing of, leaders from student government, Peer counselors, students recovering from substance abuse, Security officers, Housekeepers, Wardens, Chaplains and Counselors to provide perceptive experience on drug abuse prevention. At this stage also, purposeful sampling was used to identify SSSP in Security departments and student leadership to provide an in-depth perspective on how prevention is carried out and the challenges being encountered. The subjects of the study consisted of 3 rd and 4 th year undergraduate students on regular mode of study randomly selected from the faculties of Humanities and Social Sciences and Pure Sciences. These faculties generally host the highest number of student population in
80 64 most Kenyan universities hence the faculties were purposefully targeted to their population popularities. However, samples from PRU1 were taken from the school of communication for it hosts the largest number of students. School of Business at PRU2 university also has the largest number of students therefore it replaced the school of sciences. Focus Group Discussion comprised between 7-12 Social Support Service Providers (SSSP) consisting of counselors, chaplains, Housekeepers, security officers, student leaders and Peer counselors for every session. They were purposively selected on the basis of their perceptual experiences in drug abuse cases and provision of prevention programs in the university. Having employed purposeful sampling to select universities for study, it was necessary to employ a proportional formula n=(p (1-p)/A 2 /Z 2 +p (1-p)/N/R (Watson & Jeff, 2001) to obtain sample sizes for each of the selected universities. The sample size was determined using confidence level of 95%, precision level of 5%, estimate variance of 5% and a response rate of 0.8. The steps entailed in the formula suit the testing of the study parameters. However, for data management purposes and to have just enough samples, a further adjustment of 25% was accommodated. The main respondents of the study consisted of 425 students and 104 Social Support Service Providers. The total sample size was 499 respondents. Table 3.1 Sample size and sampling techniques Sampled Universities Student Population Categories of respondents Stud ents Social S. Providers Qualitative Interview Schedule( Total NO Sampling Technique
81 65 (FGD) QIS) PUU1 50, Cluster, Random, Purposeful PUU2 11, Cluster, Random, Purposeful PRU1 2, Cluster, Random Purposeful PRU2 2, Cluster, Random, Purposeful Total Number of respondents is Research Instruments Triangulation of research tools was found instrumental in cross-checking and substantiating findings to increase validity. Several reasons for using multiple data gathering methods are provided by Saldana (2011) Harris (2010) which comprise; guaranteeing a wider spectrum of diverse perspectives for analysis and representation. Harris (2010) argues that limitation of one data collection method can be addressed by an additional method and that multiple data collection methods enhance credibility and trustworthiness. Research tools therefore consisted of a questionnaire which was developed specifically for students with the principal objective of perceiving a glimpse of drug abuse prevention programs amongst students in the student population of the university. The questionnaire was also meant to capture details on; prevention programs in operation, programs synchronization into academic and nonacademic programs, delineation of student responsiveness to prevention programs and accessibility of
82 66 prevention programs to users. It also inquired into student and university environmental aspects deemed essential to target in prevention and the challenges faced by prevention programs. In-depth interviews were administered to various groups of students to gather information on strategies being used and students responsiveness to them. Focus Group Discussion was chosen to provide interactive information from the group as they share their views and experiences (Hesse-Biber & Leavy (2011). They were hence conducted separately on several groups encompassing social service providers consisting of counselors, chaplains, wardens, Housekeepers and security officers. The second group were students whose composition was purposively selected to include student leaders in student governments and clubs due their direct knowledge on students dynamics and prevention activities. Qualitative interview schedule was administered to leaders of peer counseling program, security officers and counselors to ensure confidentiality. Through collaborative sense-making and participants ideas, and opinions, understanding of prevention programs was captured Breakwell (2004). Observation method which Breackwell, et. al., (2008) describe as a research method in its own right as well as being integrated into other kinds of research methods was employed in this study. Direct, Non-participant structured observation guide was applied with the principal reason to find out how prevention programs factually operate Flick (2006) and to countercheck information that was obtained from other methods. It helped to establish viability of the methods used by prevention programs to disseminate information (Harris, 2010; Heppner, Wampold & Kivlinghan, 2008). To enhance the use of observation method, the S.H.E.D techniques suggested by Harris (2010) were applied to students on two specific posters on drug abuse which were found common in all the universities. These posters
83 67 instructed that drug abuse is prohibited within university premises. S.H.E.D stands for four important questions which provided an indication whether prevention programs have these qualities or not and the meaning the posters impact on students. The questions were, what do you see in the poster? How do the conditions in the poster relate to drug abuse lifestyles in your university? How can we become more empowered by the new understanding created by this poster? And what can we do to address these issues? Observation method also included several props found in universities students strategic places and those hypothesized to be main areas with frequent student traffic namely; admissions and Dean of students offices, student centers, computer centers, Library and the main entrance into the university. In each of these places, research focused on communication modes and props. It was also important to find out if there are rehabilitation centers in universities. The table 3.2 provides a summary of research tools and number of schedules as administered in each of the four universities. Table 3.2 Schedules of Research Tools administration Tool PUU1 PRU1 PRU2 PUU2 FGD QIG SOG
84 Pilot study To ascertain validity and reliability of instruments, a pilot study involving three tools initially suggested in the study was carried out at Kenyatta University being one of the first public universities in Kenya to launch a drug abuse policy in September After analyzing data from the pilot study, inevitable changes were made to replace the projective test with Qualitative Interview Schedule which was seen fit being administered separately to counselors, students in student governments and security departments whose sections were regarded sensitive. It was also found fundamental to have a separate focus group discussion with members of student governance due to their direct connection to student population and prevention programs. Through the Pilot study, discrepancies were discovered which enabled adjustment of questionnaire and qualitative guide as new insights came in during the analysis of the data. Out of the pilot study, the following valuable detections were made: Second years didn t have much information about prevention programs perhaps due to their short period in the university. It became necessary to administer questionnaires to 3 rd and 4 th years whose experience with university culture, attitudes, lifestyles and practices spans over a longer period. The pilot study revealed fundamental insinuation on acquisition of background information about the selected study sites. Uniform respondents selection criteria proposed initially were not applied in all universities because responsiveness and randomness would not have been achieved. For instance in PUU1, respondents were selected from student clubs of major schools to enhance the chance of randomness due to high number of schools and colleges in this university which would have closed out many through random selection and hence bias randomness.
85 Data collection Procedures After obtaining research permit, from the National Council for Science and Technology (NCST) and the universities under study, the researcher systematically observed the necessary protocol and procedures to access the students and Social service providers. Research Assistants who had undergone training administered and collected questionnaires. They helped the investigator with recording of the proceedings FGDS. For confidentiality purposes, the main investigator preferred to carry out in-depth interviews with selected groups of the respondents. 3.9 Validity and Reliability Validity of the study was ascertained through confining research tools and respondents to variables stipulated in the research objectives. Use of four tools; student questionnaire, Qualitative Interview Schedule, Focus Group Discussion and Structured Observation Guide allowed for collection of a wider breadth of information which reinforced, complemented and compared against each other. Direct structured or systematic observation method particularly on visual cues such as modes of communication about drug abuse prevention in universities is supported by Yin (2011) who attests that unobtrusive measures complement the collection of interviews and other data within the same qualitative study. Combination of all these research tools helped in not only strengthening validity but also in determining whether data from two or more sources converge or lead to the same finding Yin (2011). Research tools were arranged systematically in such a way that research questions in each tool matches the theme of the parameters under study. This aided in ensuring that no valid information was left out during data collection and analysis. It also expanded the source of information, Creswell
86 70 & Miller (2000). To further strengthen validity details, the researcher developed a study process framework (Appendix F) which provided a vivid guideline on all the ten indicators which were selected for examining effectiveness. Adjustments from piloting entailed replacing projective test with qualitative interview schedule due to need to enhance confidentiality and encourage openness of the discussions. During proposal defense, examination team mentioned researcher s subjectivity which was rectified through journal keeping on reflective thinking throughout research collection and analysis process. Through pilot process, clarity of questions and discussions made easy for respondents to contribute insight into the study area. Application of mix up of survey questions helped in dealing with response acquiescence, Keegan (2009). Establishment of variables to be included in the study was done through an earlier visit to the Dean of students Offices where information on the number of students in faculties and clubs was obtained. The sampling formula was then used to identify the number of students in each department to be randomly given questionnaires. Focus Group discussions were carried out amongst counselor, Chaplain, warden, two house keepers, security man, peer counselors and student leaders. This step helped in enhancing randomness and reducing bias Data analysis techniques Transcription, coding and theming was done to help organize and categorize non numerical data such as students and service providers attitudes, behaviors, value systems, concerns, perceptions, aspirations, and suggestions on the components of effectiveness of prevention programs examined in this study. Stevens taxonomy of measurement (1946) was used in this process. Each research question and parameter
87 71 falling under each question was divided into codes and themes with the aid of Computer software, NVIVO 10 whereas Statistical Package for Social Sciences (SPSS) aided in the analysis of demographic information of the respondents. Chi-square and ANOVA were used in testing the hypotheses. Systemization of the four data collection instruments namely; student questionnaire (SQ), Qualitative Interview Schedule (GIS), Focus Group Analysis Discussion (FGD) and Structured Observation Guide (SOG). Data analysis was conceptualized as shown in figure 3.1. Themes Sub-themes Synthesized Information SQ FGD QIS SOG Figure 3.1: Data analysis process In the data analysis process, two different data analysts were engaged to ensure complementarity of findings and to avert bias as suggested by Patton Quinn (2002). This was particularly important in accommodating both quantitative and qualitative techniques of data analysis.
88 Data Management and Ethical Considerations In line with general principle D of APA Ethics Code (1992) in Heppner, Wampold & Kivlinghan (2008) Ethical standards of confidentiality and honesty guided this study in collecting, keeping, discussing analyzing and releasing information obtained from the study. For this reason, a letter of introduction and an informed consent was sought to duly clarify the purpose of the study to all the respondents, Hesse-Biber & Leavy (2011) before any research was undertaken. The researcher embraced adequate responsibility to ensure that research purpose, instructions and expectations of the study were clarified to participants and duly observed. Audio/video taped materials were put under strict custody of the researcher during all the stages of the study process to avoid being tampered with.
89 73 CHAPTER FOUR DATA ANALYSIS, PRESENTATION AND DISCUSSION 4.0 Introduction This chapter presents analysis, research findings and discussions guided by the objectives of the study derived from the study purpose. The overriding purpose of this study was to assess effectiveness of drug abuse prevention programs in Public and Private Kenyan Universities. Mixed quantitative and qualitative data analysis procedures and techniques were employed. Presentation of research findings encompassed use of summary displays, diagrams, graphs and tables (Saldana, 2011; Scott & Mazhindu, 2005). Dissertation in this chapter encompassed interplay and synthesis of information from theoretical framework, research findings and researcher s experience in the field. Theoretical framework of the study espoused two theories namely, Self-Efficacy Theory by Albert Bandura (1986) and Ecological Systems Theory by Brofenbrenner (1944). Principles of effective drug abuse prevention programs derived from evaluation and assessment of Dusenbury, Hansen and NIDA (2009) on effective prevention programs are incorporated in the analyses, presentation and discussion. Section 1 provides the findings on demographic information and section two gives the findings of the study based on objective one to five.
90 PRU2 PUU1 PRU1 PUU2 Percentage Demographic information of Respondents Demographic information of the respondents was important for identifying other variables that may not have constituted the central objectives of the study but which were credible for conceptualization of possible intervening and confounding factors in substance abuse prevention. These include, age, gender, faculty, year of study and residence status of respondents. The variable asking respondents use of substance was meant to gauge the state of drug use to other research questions related to substance abuse prevention programs. Descriptive and inferential statistics were undertaken and presented in tables and graphs Respondents Gender distribution Information on gender distribution revealed that there were more males than females in all universities. Males were; PUU1 (76.3%), PUU2 (67.5%), PRU1 (57.5%) and PRU2 (75.4) compared to their female counterparts 23.7 %, 32.5%, 42.5% and 24.6% respectively as shown in figure % % 60.0% % 40.0% 30.0% 20.0% Male Female 10.0%.0% University
91 75 Figure 4.1. Distribution by Gender Gender percentages in every university seem to have taken a proportionate correlation with the number of gender representation in the clubs and schools from which respondents were drawn. This could indicate that female students were fewer in the respective clubs and departments; a trend which seems to share similarity with university enrolment spanning from academic year as shown in table 4.1. Table 4.1 Student enrolment in universities by sex. Academic year Male Female % Female 2003/4 47,088 25, /5 53,394 28, /6 53,737 27, /7 56,517 34, /8 60,504 36, /9 62,754 37, Source: GOK (2009b, 2007b). Other studies NACADA (2012) with 54.4%; Atwoli et al. (2011) with 52.2%; Barasa, Toili & China (2011) with 53% and Kyalo & Chumba, (2011 ) with 63%, Magu et al.(2013) with 69% male respondents reveal the same trend in which female respondents are fewer. Psiquiatr (2007) portrayed the same perspective. Despite this slight gender disparity, FGD and GIS were carried on with respondents participating actively in an equivalent adeptness. It was however paradoxical to discover
92 76 that most of the students who participated in student DSAPP were more female than male, using Peer Counseling program as an instance. This situation could hint out to selection criteria of students who participate in prevention programs or female students more interest in service provision in general. It could also indicate a higher number of drug users amongst the male students hence making it ironical for them to participate in prevention programs University Faculties This study had acknowledgement of the fact that universities have different faculties with varying student populations and course attributes which could influence correlates of drug abuse. During data collection, representativeness of faculties was ensured through selecting respondents from sciences and social science faculties or other faculties which had larger student populations. This strategy was meant to ascertain randomness and reliability of the study. It was important to know the faculties of respondents for comparison of responses from various faculties on the use and abuse of substances and operations of prevention programs in their faculties. However, this study did not note any significant difference in drug use or abuse among respondents of various faculties. Research findings revealed that drug abuse habits were generally same across faculties except a few comments on the fact that faculties with heavy course work seemed to have many students abusing drugs at stages of addiction. For instance, the Schools of Medicine, Health Sciences and Engineering came out amongst respondents as schools with drug abuse cases at addiction stage levels. FGD and GIS strongly contended that a portion of students abusing drugs from these faculties display quiet personalities and in most cases are brought to therapy when their drug taking habits have reached
93 Percentages 77 unmanageable levels. Attribution of faculty characteristics to drug abuse habits is an important feature that deserves consideration particularly during planning stages of programs to ensure that specific interventions are established for these populations. This is the essence of selective and indicated prevention interventions, Galanter & Kleber (2008) and as echoed out in systems theory (Ludwig Von Bertallanfy, 1968; Bronfenbrenner, 1944; Coreil, 2010) Respondents Year of Study This study selected third and fourth year students to partake the study purposefully based on the premise that their longer experience at the university holds more information than that of first and second years. Student respondents in third year were as follows; PRU2 (47.4%), PUU1 (53.1%), PRU1 (54.3%), PUU2 (33.8%) whereas those in fourth year were 52.3%, 46.9%, 45.2% and 66.2% respectively as displayed in figure % 60.0% 50.0% 40.0% 30.0% 20.0% 10.0%.0% PRU2 PUU1 PRU1 PUU2 Third year Fourth year Universities Figure 4.2: Year of study by universities However, there was no significant variation displayed between third and fourth year respondents in their perspective to questions. This uniformity in response to questions could be attributed to the fact that unit system in the university shrinks the vast variation
94 Percentages that would exist if students in different academic years had independent classes and experience. It could also indicate common application of DSAPP methods to all the students making it possible for those in different years to access information as confirmed by SOG observation of posters and fliers and student booklets. Coreil (2010); Medina Mora, (2005) argue that all the populations in a community of drug abuse prevention should be reached with appropriate programs. This hence presents a vivid indication that DSAPP in Kenyan universities should integrate all components of prevention. DSAPP spread of programs should reach all the students in all the academic years including first years in order to zip possibilities of students influencing one another into drug abuse Respondents residence It was found prudent to inquire whether respondents resided within or outside the university in case their experience with drug abuse varied. Results indicated that majority of respondents (90.7%) in PRU2, 90.8% from PUU1, 60.5% from PRU1 and 56.9 from PUU2 were residing within the university as shown in figure % % 60.0% 40.0% %.0% PRU2 PUU1 PRU1 PUU2 Universities Resident Non resident
95 79 Figure 4.3: Students residence by universities Responses to questions on awareness of DSAPP demonstrated no significant difference between resident and non-resident students as demonstrated by a chi-square performed with the following hypotheses. H 0 : There is no significant relationship between students awareness of DSAPP and their residence. Table 4.2 Chi-square tests Chi-Square Tests Value df P-Value Pearson Square Chi N of Valid Cases 295 Since the p-value (0.131) is greater than the level of significance (0.05), we do not reject the null hypothesis and conclude that there is no statistical significant relationship between students awareness of DSAPP and their university residence status. Conversely, discussions emanating from FGD and GIS insinuated the fact that students who are non-resident at the university seem to miss out on some activities such as talk shows and movies which are mainly scheduled for evenings or weekends. Pascarella and
96 80 Terenzini, (2005) assert that living in the residence halls during one's college years enhances effort and involvement in academic, social, and extracurricular activities and enables more involvement with other students, faculty, and the institution as a whole. This coincides with experience in other findings (Kloss, et.al 2012) showing that programs are more effective when they involve all members of the community. It further poses a question facing DSAPP on the best time to schedule their activities for the activities to be student all- encompassing. The sum of respondent demographic information in this study is provided in Table 4.3. Table 4.3 Demographic information of respondents Demographic variables Frequency % Male Gender: Female Year of study: Residence: 3 rd Years th Years Resident Non-resident Most Frequently Use of drugs: Frequently Rarely Never
97 Findings of the study Findings of the study are provided in this section based on the study objectives Prevention programs and activities currently at work in the university The task of this section was to find out levels and objectives of drug abuse prevention programs currently in existence in universities with the research question to establish objectives, levels and principles of drug abuse prevention programs and activities currently in existence in universities. The word programs in this section is used interchangeably with the word activities because respondents listed activities and programs without necessarily distinguishing them. The researcher however categorized them. This section gathered information on DSAPP programs and activities currently available at the university which were subjected to Classification by Public Health Model (Mrazek & Haggerty, 1994) to them to levels of prevention. Respondents listed posters, billboards, movies, motivational speakers, electronic messages, counseling, peer education, campaigns, seminars, training, music and sporting and games as the major activities (Figure 4.4). FGD and QIS confirmed that additional activities such as drug abuse prevention days, talk shows, door to door campaigns, brochures, university functions such as culture week and Christian unions whose details are provided in Appendix H were in existence.
98 82 5.2% 3.0% 2.6% 2.2%0.4% 12.3% 12.6% 61.7% Dissemination of information Not aware Guidance and counselling Lecturers involvement Peer education Drug abuse policy Punishment on drug abusers Common unit on drug abuse Figure 4.4: Ways DSAPP carry out their activities There was no strong demonstration of secondary and tertiary levels of prevention in the listed activities. The following excerpts from student respondents further illustrate this; Students who are addicted are admitted to the university sick bay where there is no meaningful treatment apart from a Psychiatrist who occasionally visits them. I wouldn t consider this as any attention to the addict at all. (Student Public University) We hear there are rehabilitation centers in this country but students who are addicted are never taken to these rehabs. Most of the cases have ended up dropping out of the university. (Student, Private University) We liaise with university Psychiatrist who comes once a week on matters of addiction but most students whom we refer to the rehabilitation centres do not afford the charges because they are quite high. (Counselor, Public University) Rehabilitation centres have their own challenges apart from inflated financial costs. Some students complain of lack of facilities and lack of compatibility in terms of intellectual levels. Some have had to escape before serving full rehabilitation terms due to such conditions. (Counselor, Public University)
99 83 The conclusion derived from the above information reveals that there is a predominance of primary level of prevention as defined by Public Health Model (Mrazek & Haggerty, 1994). There were dismal evidence of other components of prevention levels such as outpatient services offered by counselling and chaplaincy services. Referral to rehabilitation centers in the country is a measure used by many universities to deal with cases of addictions because there is no university which had established their own drug rehabilitation center by the time of this study. This is an indication that secondary and tertiary levels of prevention are not well established in most universities. However, one principle of effective prevention programs states that prevention programs should address all forms of drug abuse, alone or in combination, including the underage use of legal drugs (e.g., tobacco or alcohol); the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained substances (e.g., inhalants), prescription medications, or over-the-counter drugs (Johnston et al. 2002, in NIDA 2003). This uncovers DSAPP insubstantiality in the area of policy establishment. At the time of study, most universities did not have drug abuse policy in place whereas others were at the verge of developing one. Drug abuse policy is crucial in guiding implementation activities hence should be one of the structures to ensure effective prevention. Considering the complexity web of drug abuse-causing factors such as social interactions, drug availability and university comrade euphoria, it would be more imperative to put in place all the levels of prevention in order to avoid the spiraling effect of emulation of drug abuse behaviors. The theoretical framework (Self efficacy and Ecological systems theories) in this study clearly demonstrates this that, students perceptions of peers
100 84 alcohol consumption and cannabis use predicts and explains a significant amount of variance in alcohol and cannabis use (Kilmer et al., 2006; Perkins et al., 2005). This shows that it doesn t suffice to dwell on primary prevention services alone because it would ignore other populations in secondary and tertiary levels resulting in them permeating their drug taking habits to other members. Further findings reveal that all the levels of prevention are required because drug abusers fall in primary, secondary and tertiary categories and prevalence rate being high with all sampled universities disposing with similar drug use as evidenced by FGD and GIS. Sentiments from SSP respondents which were similar in all universities appear to send a disconcerting fret on the state of drug abuse in universities with accompanying concerns of whether DSAPP are employing the right prevention strategies on the right target or not. However, from this study, information does not vividly provide an accurate numerical picture of students in drug abuse. Foregrounding activities such as baseline surveys and other factors such as drug abuse policy implementation which were missing would not only reveal prevalence and incidence of drug abuse but also the type of drugs being abused to form a good informational basis for establishment of efficient prevention programs. This is vividly postulated by the Precede-Proceed Model (Green, L.W., & Kreuter, M.W. (2005) in figure 4.5 which advocates that preceding activities in any prevention program are those to be undertaken before any intervention takes off and they include; predisposing, reinforcing and enabling constructs in educational and environmental diagnosis and evaluation. Proceed refers to policy, regulation and organizational constructs.
101 85 Figure 4.5: The Precede-Proceed Model Source: Green & Kreuter (2005). DSAPP effectiveness could be enhanced through application of stages of program implementation development. In this study, though primary prevention was found common amongst the universities under study, it significantly lacked in interventions specific to individuals, environmental and selectivity to drug types. Markwood (2011)
Make A Difference Take Action Reach Out Red Ribbon Your Community Focus On Prevention U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration www.samhsa.gov
How to Develop a National Drug Policy A Guide for Policymakers, Practitioners, and Stakeholders Organization of American States (OAS) Inter-American Drug Abuse Control Commission (CICAD) Caribbean Community
ARC resource pack Study material Foundation module 7 Psychosocial support http://www.arc online.org Page 1 of 47 Contents Introduction 7 Definitions of terms 7 Section 1 What is psychosocial support and
Position Statement Developmentally Appropriate Practice in Early Childhood Programs Serving Children from Birth through Age 8 Adopted 2009 A position statement of the National Asssociation for the Education
The Special Issue on Behavioral and Social Science Centre for Promoting Ideas, USA www.ijhssnet.com GOVERNMENT AND SOCIETAL EFFORT TO ADDRESS VULNERABILITY LEADING TO RISKS RELATED TO DRUG AND SUBSTANCE
Characteristics of EXCELLENCE in Higher Education Requirements of Affiliation and Standards for Accreditation Online Version - Revised March 2009 (pages xii and xiii) Middle States Commission on Higher
What Works to Prevent Partner Violence? An Evidence Overview Working paper (version 2.0) December 2011 Lori L. Heise Senior Lecturer Centre for Gender Violence and Health London School of Hygiene and Tropical
Preparing a health care workforce for the 21st century T H E C H A L L E N G E O F C H R O N I C C O N D I T I O N S World Health Organization Noncommunicable Diseases and Mental Health Cluster Chronic
APR. 03 U.S. Department of Justice Office of Justice Programs National Institute of Justice Special REPORT Residential Substance Abuse Treatment for State Prisoners WEB-ONLY DOCUMENT Implementation Lessons
December 2009 Evaluation of Provision and Support for Disabled Students in Higher Education Report to HEFCE and HEFCW by the Centre for Disability Studies and School of Sociology and Social Policy at the
SUBSTANCE ABUSE TREATMENT: WHAT WORKS FOR HOMELESS PEOPLE? A REVIEW OF THE LITERATURE PREPARED FOR TRANSLATING RESEARCH INTO PRACTICE SUBCOMMITTEE NATIONAL HCH COUNCIL & HCH CLINICIANS NETWORK RESEARCH
Heading home: the right thing to do 10 Year Plan to End Homelessness 2010 2020 www.woodbuffalo.ab.ca 1 ACKNOWLEDGEMENTS The Regional Municipality of Wood Buffalo would like to thank the many individuals
FOR CANDIDATES APPLYING 2011 OR LATER. English as a New Language Standards Second Edition for teachers of students ages 3-18+ National Board Certification for Teachers English as a New Language Standards
FAMILY VIOLENCE HURTS EVERYONE: A FRAMEWORK TO END FAMILY VIOLENCE IN ALBERTA Table of Contents Message from the Minister and associate Minister 3 Building Alberta Through Strong Families and Communities
ST/ESA/STAT/SER.F/89 Department of Economic and Social Affairs Statistics Division Studies in Methods Series F No. 89 Manual for the Development of A System of Criminal Justice Statistics United Nations
good habits of mind good habits of mind A mental health promotion initiative for those working with young people in out-of-school settings Acknowledgements The following people are acknowledged for their
Conducting Effective Substance Abuse Prevention Work Among the Youth in South Africa GUIDELINES Contact details: The Representative Regional Office for Southern Africa United Nations Office on Drugs and
REHABILITATION CONCEPTUAL FRAMEWORK February 13 th, 2012 Interprofessional Practice Health Professions Strategy and Practice Rehabilitation Conceptual Framework - I Executive Summary The Rehabilitation
2 COMMUNICATION, MANAGEMENT AND HEALTH GOALS AND CONTENTS The University of Lugano (USI), Switzerland, in collaboration with Virginia Polytechnic Institute and State knowledge and skills to Acquire the
Climate Surveys: Useful Tools to Help Colleges and Universities in Their Efforts to Reduce and Prevent Sexual Assault Why are we releasing information about climate surveys? Sexual assault is a significant
Making Diversity Work on Campus: A Research-Based Perspective By Jeffrey F. Milem, Mitchell J. Chang, and Anthony Lising Antonio One in a series of three papers commissioned as part of the Making Excellence
U N D E R S T A N D I N G B O S T O N Preparing Our Kids for Education, Work and Life A Report of the Task Force on Youth Aging Out of Care Task Force Co-Chairs Cambridge Family & Children s Service and
When Will We Ever Learn? Improving Lives through Impact Evaluation Report of the Evaluation Gap Working Group May 2006 Evaluation Gap Working Group Co-chairs William D. Savedoff Ruth Levine Nancy Birdsall
Report of the Task Force on Drug Addiction Treatment to the King County Bar Association Board of Trustees May 15, 2001 King County Bar Association Drug Policy Project 900 Fourth Avenue, Suite 600 Seattle,
SUPPORT MANUAL FOR DEALING WITH SUBSTANCE USE ISSUES IN AN OUT OF SCHOOL SETTING SUPPORT MANUAL FOR DEALING WITH SUBSTANCE USE ISSUES IN AN OUT OF SCHOOL SETTING 06 SUPPORT MANUAL FOR DEALING WITH SUBSTANCE
TAKING OUR PLACE: U NIV ERSITY O F MAN ITOBA 2 0 1 5-2 020 STRATEGIC PLAN TABLE OF CONTENTS Message from the President...3 Introduction... 4 Planning Context....5 Consultations: What We Heard....7 Acknowledgement...