1. الحمد لله والصلاة والسلام على رسول الله
الحمد لله والصلاة والسلام على رسول الله
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2. تقصي ظاهرة الإدمان بين طلبة المدارس الثانوية المصرية Addiction among Egyptian secondary school students
Research Unit وحدة الأبحاث
GSMHAT الأمانة العامة للصحة النفسية وعلاج الإدمان
MOH, Egypt وزارة الصحة, جمهورية مصر العربية
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3. MedSPAD Mediterranean School Survey Project on Alcohol and other Drugs
Adopted from the ESPAD (European countries)
Arab countries started to participate, Lebanon, Morocco, Tunisia, Algeria, Egypt, and others coming soon….
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4. Special thanks شكر خاص الجهاز المركزي للتعبئة العامة والإحصاء
إدارة الطب النفسي للأطفال والمراهقين
إدارة علاج الإدمان
إدارة العلاقات الخارجية
إدارة الإعلام
الفريق المالي والإداري بالأمانة
الأمين العام للصحة النفسية وعلاج الإدمان
CAPMAS
Department of child and adolescent psychiatry
Department of Addiction treatment
Department of external affairs
Media department
Financial and managerial team
The General secretary of Mental health and addiction treatment
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5. The Egyptian population
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6. The Egyptian Population
16th largest population over the world
3rd largest population in Africa after Nigeria and Ethiopia
Largest Arab population
In 2007 = 75,480,426  In 2016 = 91,023,393
In 2016
Males = 46,413,993 (50.991%)
Females = 44,609,400 (49.009%
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8. Egyptian schools المدارس المصرية
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10. Students population 18,555,232 whole school students population
1,475,472 secondary school students (~14-17 years old)
1,609,879 technical sec school students (~14-17 years old)
3,085,351 candidates for this study (14-17)
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11. فريق الخبراء
ا.د. هشام رامي: أستاذ الطب النفسي – جامعة عين شمس. الأمين العام بالأمانة العامة للصحة النفسية وعلاج الإدمان.
ا.د. ممتاز عبد الوهاب: أستاذ الطب النفسي وعلاج الإدمان – جامعة القاهرة. مدير المرصد القومي للإدمان.
ا.د. نها صبري: أستاذ الطب النفسي – جامعة القاهرة. رئيس وحدة الأبحاث بالأمانة العامة للصحة النفسية والإدمان. الخبير الاستشاري في مجال البحث العلمي ووضع الاستبيان.
ا.د. أماني هارون: أستاذ الطب النفسي وعلاج الإدمان - جامعة عين شمس. الخبير الاستشاري في مجال علاج الإدمان.
ا.د. مها الجعفري: أستاذ الصحة العامة وطب المجتمع - جامعة عين شمس. الخبير الاستشاري في تصميم الدراسة والتحليل الإحصائي.
د. محمود الحبيبي: أستاذ مساعد الطب النفسي وعلاج الإدمان – جامعة عين شمس.
د. ريهام علي: استشاري الطب النفسي ومدير إدارة التدريب بالأمانة العامة للصحة النفسية وعلاج الإدمان.
د. محمد محمود: أخصائي الطب النفسي بإدارة العلاقات الخارجية بالأمانة العامة للصحة النفسية وعلاج الإدمان.
د منن عبد المقصود: أستاذ مساعد الطب النفسي – جامعة عين شمس. منسقة البحث.
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12. Egyptian experts meeting
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13. Pilot study الدراسة الاستطلاعية
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14. Pilot Study (6 months) Logistics Tool Team Selection Approvals
Paper work
Logistics
Questionnaire
Modification
Tool
Team formation
Team training
Team

15. The questionnaire
The questionnaire was adopted from the previous questionnaires in Arab countries (Algeria, Tunisia and Morocco).
The team added socio-demographic, clinical questions, the Strengths and Difficulties Questionnaire and questions from the Young Internet Addiction Test.
A committee revised the questionnaire to make it suitable for the Egyptian culture.
The questionnaire was refined, finalized and redecorated to make the questionnaire more student-friendly.
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17. فريق العمل في الدراسة الاستطلاعية
ا.د. نها صبري: أستاذ الطب النفسي – جامعة القاهرة. رئيس وحدة الأبحاث بالأمانة العامة للصحة النفسية والإدمان. الخبير الاستشاري في مجال البحث العلمي ووضع الاستبيان.
د. ندى أبو المجد: استشاري الطب النفسي, ومدير إدارة علاج الإدمان - بالأمانة العامة للصحة النفسية وعلاج الإدمان.
د. إيمان جابر: استشاري الطب النفسي, ومدير إدارة علاج الأمراض النفسية لدى الأطفال والمراهقين - بالأمانة العامة للصحة النفسية وعلاج الإدمان.
د. تامر بسيوني: أخصائي الطب النفسي بإدارة علاج الأمراض النفسية لدى الأطفال والمراهقين - بالأمانة العامة للصحة النفسية وعلاج الإدمان.
د. وائل خفاجي: أخصائي الطب النفسي بوحدة الأبحاث - بالأمانة العامة للصحة النفسية وعلاج الإدمان.
د. عادل عجواني: أخصائي الطب النفسي بإدارة العلاقات الخارجية - بالأمانة العامة للصحة النفسية وعلاج الإدمان.
د. مصطفى الشاهد: مدرس الصحة العامة وصحة المجتمع – كلية الطب – جامعة عين شمس.
د. منال عابد: استشاري الطب النفسي بإدارة علاج الإدمان - بالأمانة العامة للصحة النفسية وعلاج الإدمان.
د, أمينة لطفي: أخصائي الطب النفسي بإدارة العلاقات الخارجية - بالأمانة العامة للصحة النفسية وعلاج الإدمان.
د. صفاء عراقي: أخصائي الطب النفسي بإدارة علاج الأمراض النفسية لدى الأطفال والمراهقين - بالأمانة العامة للصحة النفسية وعلاج الإدمان.
مايكل جورج وفادي عادل وجورج يوسف, موظفين إدخال البيانات والأعمال اللوجستية بوحدة الأبحاث.
د. منن عبد المقصود: أستاذ مساعد الطب النفسي – جامعة عين شمس. منسقة البحث.
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19. Pilot study - April 2015
Conducted in “Abbassia nursing secondary schools” (boys and girls).
Necessary approvals were provided and informed consents were distributed to the students 3 days before conducting the pilot study questionnaire.
Instructions to the ‘previously trained’ researchers were distributed before the data collection.
Feedback report about the cooperation, the difficulties and the numbers of participating students, numbers of absentees and the number of parents refusals.
22/4/2015  boys' school
27/4/2015  girls' school
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20. Implicationsفوائد الدراسة الاستطلاعية
Testing applicability of the questionnaire.
Removing the confusing questions
Questions about different levels of prevalence rearranged and clarified.
The sample of the main study was decided to be at least students to be representative and to yield valid prevalence rates.
The sample has to expand to other regions in the whole country. Cairo alone will be a bias.
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21. Mental Health and life habits among Egyptian school students Main study
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23. Approvals: MOE approval was received on 3/2016.
CAPMAS approval was received on 12/2015
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24. Sample selection:
The experts’ council chose 3 governorates, each representing an Egyptian geographical region:
61 schools from Cairo (the capital)
34 schools from Menoufeya (representing lower Egypt Delta)
34 schools from Assiut (representing upper Egypt)
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25. Sample selection and task assignments
From Cairo, the target population was 6147 students in 155 classes from 61 high schools were selected: 27 general, 11 industrial, 14 of commerce and 9 Azhari schools).
This was the responsibility of 6 supervisors (1025 questionnaires each) and 30 researchers (205 questionnaires each)
From Menoufeya, the target population was 3424 students in 86 classes from 34 high schools were selected: 8 general, 8 industrial, 6 of commerce, 6 agricultural and 6 Azhari schools).
This was the responsibility of 3 supervisors (1141 questionnaires each) and 15 researchers (229 questionnaires each)
From Assiut, the target population was 3429 students in 86 classes from 34 high schools were selected: 6 general, 2 industrial, 9 of commerce, 11 agricultural and 6 Azhari schools).
This was the responsibility of 3 supervisors (1143 questionnaires each) and 15 researchers (229 questionnaires each)
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26. Training of Trainers (TOT)
Training of the trainers and supervisors:
A training session was conducted on 24/3/2016.
Prof Menan Rabie and Dr Azza Khalil
attended by 12 highly selected supervisors from the 3 governorates (6 for Cairo, 3 for Menoufeya and 3 for Assiut)
Informed about the idea of research and assigned to train researchers to follow the designed steps
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27. T.O.T.
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28. Training
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29. Steps of Field work
The steps of the field work during April were closely followed up by Dr Azza Khalil, who managed to solve all the problems faced by the researchers:
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30. Step 1
To distribute the informed consent form to every student to be recollected within 3 days
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31. Step 2
To distribute the questionnaire to all the students who didn’t bring a parent refusal.
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32. Step 3
To read aloud the 1st page of the questionnaire. This describes the idea, the purpose and some instructions to fill in the questionnaire.
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33. Researchers only supervise
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34. And clarify if asked
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35. Students were keen and cooperative
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37. Having fun
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38. Paying attention
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39. And even proud
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40. To recollect the questionnaire into opaque envelopes or boxes after about 45 minutes
Step 4
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41. Step 5 To fill in the researcher feedback form.
designed to detect the opinions of the researchers and their experience while the students were applying the study tool.
write a report about the whole experience.
العدد الكلي للطلبة في الفصل:
عدد الطلبة الغائبين عن الفصل:
عدد الطلبة الرافضين للمشاركة:
هل كان الفصل هادئ ومتعاون؟ نعم / لا
كم عدد الطلبة الذين انتهوا من ملء الاستبيان قبل الوقت المحدد؟ نعم / لا
كم عدد الطلبة الذين استغرقوا وقت أكثر من المطلوب لملء الاستبيان؟ نعم / لا
هل كان الطلبة يستفسرون عن الأسئلة؟ نعم / لا
الأسئلة التي استفسر عنها الطلبة:
اقتراحات لتحسين طريقة البحث:
تاريخ إجراء البحث اسم الباحث الميداني
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42. Step 6
To revise (in another setting) the data on page 1: name of the researcher, name of the supervisor, the region, and the code.
They were asked not to change any of the signs made by the students.
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43. Step 7
To deliver the questionnaires to the regional supervisor who double-checks the questionnaire and provides the whole pile of questionnaire to the central office of the Research unit GSMHAT.
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44. Finally …
A total number of questionnaires were received of them were fit for analysis.
SPSS sheet was prepared and revised in June 2016 by Prof Noha, Maha, Dr Wael and Mr Fady.
Data Entry was accomplished in March 2017
Statistical analysis was started in April 2017 by Prof Maha, and Dr Amina.
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45. Description of the sample
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46. The sample
The plan was to examine students in 327 classes.
An actual number of students were approached.
On the day of the study,
2392 students were absent,
537 students reported refusals
261 questionnaires were unfit for analysis for inadequate information.
13838
2392 absent
537 refused
10648
261 unfit
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47. Sociodemographics of the sample Age & Gender
The final sample was students (4385 males, 6263 females);
Their ages ranging between 14 and 17 years old.
The majority (49.4%) were 16 years old.
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48. Sociodemographics of the sample Regional distribution
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49. Sociodemographics of the sample parents education
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50. Sociodemographics of the sample perceived economic status
Two thirds perceived their families’ economic status to be a good as other families.
Less than the third perceive their families as better than others,
a smaller proportion (2.7%) perceive their economic level as lower than other families.
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51. Sociodemographics of the sample family structure
Small family
80.5%
Extended family
18.0%
Parents‘ absence
Separation
Travelling
Death
Absent Father
14.6%
12.8%
50.9%
36.3%
Absent Mother
2.6%
27.0%
45.9%
27.2%
The majority of the families was small nuclear families as usual in the Egyptian culture. The fathers were absent in 14.6% of the cases most commonly due to travelling reasons. The mother’s absence from the family was less common (2.6%).
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52. Satisfaction by Relationships with Others
Relationships with parents, siblings and friends perceived as satisfactory for most of the sample.
50% satisfied by their relationship with the teachers, while about 20% were not satisfied.
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53. Leisure time activities
An impression about their life style and the level of social interaction they exert.
The Internet surfing was the most common hobby (47.7%).
majority of the boys are commonly practicing sports (78.7%).
Indoor activities were more practiced by girls e.g. TV and reading.
Male students were more interested in outdoor activities, e.g. Café, parties and Billiard games.
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54. Self-reported medical and psychiatric illnesses
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55. self-reported MH health phenomena
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56. The students seek help from
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57. Awareness of common substances
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58. Awareness of common substances
The majority of the students were familiar with the names of all available substances:
Cannabis, Tramadol and alcohol, the most notorious.
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59. Substance use among students’ families
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60. Substance use among students’ families (excluding tobacco)
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61. Substance use among students’ friends
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62. Substance use among students’ friends (excluding tobacco)
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63. SU among students’ friends and families
The students were asked about the contact between their surrounding people (family and friends) and the substances of abuse.
Nicotine was the most commonly used substance by the relatives of female students, and the friends of male students.
Cannabis was the most commonly used substance among relatives of both male and female students.
Among the friends of male students the anabolic steroids were frequently used as well.
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64. Substance use among students
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65. Substance use among students
The questionnaires were
anonymous
completed under exam/test conditions
With no interference from the supervisors
Who are social workers from another school
to guarantee the highest confidentiality.
These procedures encouraged the students to declare the actual status of their contact with substances of abuse.
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66. Self-reported substance use among students
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67. Tobacco use among secondary school students
Gender differences in tobacco
Self reported Tobacco prevalence
Age at onset of tobacco use
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68. Alcohol use among school students
lifetime prevalence of Alcohol use is 3.6%, with higher frequency among male students than female students.
last month prevalence is markedly lower than lifetime and last year prevalence, which gives the impression that it is not used regularly and hence not one of the preferred substances.
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69. Cannabis vs BDZ among school students
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70. International rates
In 2015, nearly half of US high school seniors admitted using an illicit drug (excluding alcohol or tobacco) in their lifetime.
21% of grade 8 & 58% for grade 12 students reported having consumed Alcohol, (Johnston et al, 2016).
The cannabis has been the most commonly used by adolescents (Peiper et al, 2016)
in a sample from the adult population 66.4% reported drinking alcohol, 30.9% smoking cigarettes, 9.0% using marijuana and 2.5% using cocaine in the last year (Kandel et al, 1997)
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71. Subjective reasons for substance use
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72. Regular use and dependence syndrome
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73. Regular use among students
Prevalence of regular use of any substance (excluding nicotine) is 1.48%
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74. Dependence syndrome among students
Prevalence of the dependence syndrome of any substance (excluding nicotine) is 0.86%
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75. Information and Attitude of students towards substance use
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76. Students’ opinions about drug accessibility
Majority of students did not know whether it is easy or difficult to acquire the substances,
28.1% thought it is very easy and easy.
11.5% thought it is difficult or very difficult.
Coffee shops are the main places of distribution.
Pharmacies and clubs come in the second place for the female students.
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77. Perceived dangerousness of substance use
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78. conclusion
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79. Conclusion
The majority of the students were familiar with the names of available substances: Cannabis, Tramadol and alcohol the most notorious.
Nicotine (cigarettes and water pipe) were the most commonly used substance by the relatives of female students, and the friends of male students.
Cannabis was the most commonly used substance among relatives of both male and female students.
Among the friends of male students the anabolic steroids were frequently used as well.
Male students showed higher prevalence than female students in the use of all substances
The majority of the students started substance use at an age between 11 and 14 years old.
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80. Conclusion
The most used substance during lifetime was the tranquilizers (Benzodiazepines), while the Cannabis (natural and synthetic) was most used during the last 12 months and during the last 30 days.
The lifetime prevalence of tranquilizers (benzodiazepines) use e.g. Xanax, Apetryl, etc… is the highest among the substances of abuse declared by the students. However, the last year and the last month prevalence are quite the same, highlighting that these substances are used regularly.
The lifetime prevalence of Alcohol use among students is 3.6%, with higher estimates among male students than female students. However, the last month prevalence is markedly lower than lifetime and last year prevalence, which gives the impression that it is not used regularly and hence not one of the preferred substances.
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81. Conclusion
Organic solvents are relatively common in the Egyptian market. The lifetime prevalence of their use reached 3.09% and 4.13% among male students.
The lifetime prevalence of cocaine use (2.33%) is exceeded that of the different types of opiates (Tramadol: 1.64%, Heroin: 1.06% Opium and/or morphine: 1.78%). Ecstasy was found to be a more popular stimulant than cocaine among the young people. The lifetime prevalence for ecstasy use was 2.16% which is comparable to that of cannabis use 2.72%.
As declared by the students, the main reasons provided by them to use such substances were alleviate distress, join their peers and overcome problems. The male students stated they used in the main to join their peers, overcome a failed love affair and to relieve their grief. Meanwhile, females were attuned to use to better concentrate overcome distress, overcome problems and loneliness.
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82. Conclusion
The coffee shops are the main places of distribution mainly for the male students, while the pharmacies and clubs come in the second place mainly for the female students.
The majority of students did not know how dangerous the substances of abuse are, or they perceived all the types as dangerous, while a smaller proportion of students had different opinions about the risk of use and whether it is related to regular use or not. This may throw light on what strategies to use to raise the awareness amongst those that do not use at all and those that have started to dabble in the use of such substances in relation to the dangers of substance abuse.
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85. Problematic internet use
24.3%  problematic internet use, 2.7% internet addiction
22% stay longer than planned .
15.5% always make new relationships online 23.7% sometimes
(23.5%) their family members or friends complain of long time they spend online
time spent on the Internet comes on the expense of other daily activities: 15.6% always , 22% sometimes and 9.9%rarely
check their personal accounts before they start any activities on the internet ; 17.8% always 19.9% sometimes
Impassioned for getting online : 21.5 % sometimes, 13.4%always
17.9% always sleep late for staying online , 22.5% sometimes
18% found it’s very hard to stop using the internet, 19% sometimes
23.4% always had the intention to reduce their time on internet, 21.9% sometimes think about it
18.5% prefer to spend time online rather than outings ,10.6%always
19.9% always find that the internet improves bad mood 21.3% sometimes
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86. Internet use
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