SUBSTANCE ABUSESUBSTANCE ABUSE

Dr.ANOOP.G Dr.ANOOP.G MBBSMBBS

Medical OfficerMedical Officer

Substance Abuse Awareness&screening Substance Abuse Awareness&screening Program, Attapady(jan-march 2011)Program, Attapady(jan-march 2011)

ATTAPPADYATTAPPADY

• Largest tribal block in Kerala• Southward extension of Gudalur plateaus of

Nilgiris• Average elevation 800-1000m• AGALI-PUDUR-SHOLAYUR panchayaths• Block CHC+3 PHC+Tribal speciality

Hospital+Pilot dispensary(Mukkali)• 80 km from Palakkad….• Coimbatore 30km from Anakkati

• Malleshwaran Peak-2000m high

• 3 major tribes-Irula>muduga>kurumba

• Tamil population

• 171 HAMLETS

• Silent Valley National Park

THE PROBLEM……THE PROBLEM……

THE BEGINNING………THE BEGINNING………

GOVT.TRIBAL VOCATIONAL GOVT.TRIBAL VOCATIONAL HSS,PUDURHSS,PUDUR

OCTOBER 2010OCTOBER 2010

IT WAS SHOCKING…IT WAS SHOCKING…

A SURVEY AT GOVT.TRIBAL A SURVEY AT GOVT.TRIBAL SCHOOL ,PUDUR……SCHOOL ,PUDUR……

• TOTAL SCREENED83(40+28+15)-81 BOYS and 2 GIRLS

• CLASSES9,10,+1,+2,VHSC 1st yr,VHSC 2nd yr

• TOTAL No. OF STUDENTS ACTIVELY USING NICOTINE AND RELATED PRODUCTS47

• Major SourceHOSTEL>SHOPS NEAR SCHOOL>HOME

• POOR ORAL HYGEINE/STUDENTS REQUIRING DENTAL CONSULTATION21

• ?PREMALIGNANT LESIONS4

• ?Leukoplakia- 3

• ?Erythroplakia-nil

• ?Sub mucous fibrosis-1

• No. OF STUDENTS REFERRED BY DENTIST TO TERTIARY CARE CENTRE2

• ALCHOHOLICS????nil

• No. OF STUDENTS HAVING EITHER/BOTH/ALL FAMILY MEMBERS USING NICOTINE/ALCHOHOL64

OUR ISSUE OF CONCERN……….OUR ISSUE OF CONCERN……….

• 1.SUBSTANCE ABUSE AMONG SCHOOL CHILDREN………………

Parental useMedia EasyAvailablityPeer pressure/group psychologyLack of awareness about hazardsLack of support groups/psychological

intervention

THE RESULT IS………THE RESULT IS………

• 1.POOR ATTENDANCE

• 2.POOR ACADEMIC PERFORMANCE

• 3.ANTI SOCIAL BEHAVIOUR/CRIMES/SUICIDES

• 4.HEALTH HAZARDS (PHYSICAL&PSYCHOLOGICAL)

ACTION PLAN…….ACTION PLAN…….

ATTAPADY PROJECTATTAPADY PROJECT

JAN 2011-MARCH 2011JAN 2011-MARCH 2011

FUNDED BY NRHM ,PALAKADFUNDED BY NRHM ,PALAKAD

SCREENING CARDSCREENING CARD

• Bio-data

• Details of use-SELF&FAMILY

• Awareness of hazards

• Oral cavity screening

• Dental-Psychiatry referal

• STEP 1Identify high risk areas/areas requiring active intervention……………..SCHOOLS

• STEP 2Awareness program for teachers/brief introductory session

• STEP3 SCHOOL HEALTH JPHN&TEACHERS should identify high risk group(can form an action council including teachers,HM,students)

• STEP 4Maintain a health record/profoma

• STEP 5group counselling/awareness by demonstration and ORAL CAVITY SCREENING

• STEP 6DENTIST evaluation and appropriate referral.

• STEP 7TERTIARY LEVEL intervention and appropriate management

• STEP8PSYCHOLOGIST/PSYCHIATRIC support ,awareness,motivation

• STEP 9PLEDGE,POSTER /ESSAY COMPETITION/MONITORING GROUPS

SCREENING SCREENING CARDCARD

• 1.NAME 2.AGE 3.SEX 4.ADDRESS 5.FATHER’S NAME 6.MOTHER’S NAME

• 7.SCHOOL 8.CLASS 9.TRIBE/NON TRIBE• ----------------------------------------------------------------• 10.History of substance abuse?(yes/no)• 11.Agent of abuse and form??tobacco,alchohol?• 12.duration and frequency?• 13.Abuse-agent&form,duration in parents/siblings• 14.FIRST USE--?HOME/FRIENDS/HOSTEL or

SCHOOL?• ----------------------------------------------------------------------

• 15.Are you aware of HAZARDS?• 16.Whether previously given counselling/class?• 17 .if yes,mention 2 areas affected and the hazard• 18.your idea of CANCER?• 19.Have you ever tried stopping?• 20.if resumed,what was your difficulty?• ----------------------------------------------------------------• 21..GIVEN BELOW ARE LIST OF CHEMICALS IN

SMOKE…MATCH THEM AGAINST AGENTS WHETHER THEY ARE FOUND.

• 22.ATTENDANCE REGULARITY?• 23.ACADEMIC PERFORMANCE?• 24.WHETHER INVOLVED IN CO-CURRICULAR

ACTIVITIES?• ------------------------------------------------------------• BP- • ORAL CAVITY-oral hygeine?

Halitosis,teeth,gums,tongue,palate,lips,buccal mucosa

• --Premalignant lesions if any?• -- Referal required?(y/n)

FROM SPARK TO FIRE…FROM SPARK TO FIRE…

FROM SPARK TO FIRE.FROM SPARK TO FIRE.

• TOTAL schools screened-29

• Students “at risk” screened-317(306 boys +11 girls)

• Age group= 6-11yrs-27,11-13yrs-113,14-16yrs-123,17-19yrs=51

• 148 hostlers and 169 day scholars

• Only chewables-280,only smoker-2,only alchohol-3,both 1&2=2,1&3=10,all=20

• Occasional=84,<1yr=89,1-2yr=65,>2yr=79

• Occasional=76,1/wk=112,2/wk=53, 3/wk=30,>3/wk=46

• Source-not applicable=8,home=72,shop=192, hostel=36,>1 source=9

• Income-home=257,friends-28,self-20,>1 source=5

REASON FOR STARTINGREASON FOR STARTING

• Parental use=271

• Friends=125

• Tension reliever=125

• Curiosity=125

• Sense of maturity=115

ATTEMPT TO STOPATTEMPT TO STOP

• 172 attempted,145 did not

• 135 of the 172 FAILED IN THEIR ATTEMPT

REASON FOR FAILUREREASON FOR FAILURE

• Sleep affected=59

• Cant attend class properly=94

• Peer pressure to continue=94

• Physical symptoms=41

• Stress mounting up=84

AWARENESS ABOUT HAZARDSAWARENESS ABOUT HAZARDS

• Good=25

• Satisfactory=88

• Poor=104

• Short span-before financial year(march)

• Focused more on practical aspect, less emphasis on objective study

• Geographical limitations

• Apprehension among teachers

35 SCHOOLS….35 SCHOOLS….

• 306 males and 11 females

• 6-11yrs(27) , 11-13yrs(116),14-16yrs(123) ,17-19yrs(51)

• 148 hostlers and 169 dayscholars

• Only chewables(280),only smoking(2) , only alcohol(3) ,1&2- 2,1&3- 10 all three-20

• <1yr(173),1-2yrs(69) , >2yr=79

• Occasional(84),1/wk(108),2/wk(53), 3/wk(30), >3/wk(46)

• Home(80),shops(192),hostel(36), >1 source (9)

• Source of income-home(264),friends(28), self earned (20),>1 source-5

• Parental use(271),friends(125), tension reliever(134) , curiosity(125), sense of maturity(115)

• 172 attempted to stop while 145 did not

• Of 172 only 35 succeeded….(period from starting of this project taken)

• Reasons for failure-affected sleep(59) , unable to concentrate in class(94) ,peer pressure to continue (94) , stress(84) , physical symptoms(41)

• Awareness about hazards-good(25) , satisfactory (88) , poor (104)

ORAL CAVITY SCREENINGORAL CAVITY SCREENING

• Done=279

• 76 dental referal

• --62 oral cavity changes

• --13 leukoplakia

• --1 oral submucus fibrosis

PSHYCIATRY REFERALPSHYCIATRY REFERAL

• 284 wanted some help from doctor

• 33 of them did not want

REASON FOR SUCCESSREASON FOR SUCCESS

• Target group-school children ---parents• Ban imposed by District Collector• Health-Police-Excise co-ordination• NGOs-Other organisations incorporated• Psychologist-Psychiatrist support• Visual-Auditory medias used• Student police concept• ABOVE ALL……MANAGED ALMOST SINGLE

HANDEDLY….

LIMITATIONSLIMITATIONS

• Short time span-less statistical

• Geographical conditions

• Apprehension among teachers

ACHEIVEMENTSACHEIVEMENTS

• proposal for School health JPHN for all schools-Attapady

• Monitoring cells-awareness campaigns

• BAN IMPOSED BY GOVT ON PRODUCTS

THANK YOUTHANK YOU