|ORIGINAL RESEARCH REPORT
|Year : 2021 | Volume
| Issue : 1 | Page : 8-13
Willingness to quit substance abuse in motor parks among commercial drivers in Lagos, Nigeria - A cross-sectional study
Olanrewaju Olusola Onigbogi1, Modupe Olajumoke Onigbogi2, Tinuola Omotomilayo Odugbemi1, Omobola Yetunde Ojo3
1 Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
2 Department of Epidemiology, University of Texas Health Science at Houston, Houston, TX, USA
3 Department of Community Medicine and Primary Care, Federal Medical Center, Abeokuta, Ogun State, Nigeria
|Date of Submission||21-Feb-2020|
|Date of Acceptance||27-Aug-2020|
|Date of Web Publication||2-Feb-2021|
Dr. Olanrewaju Olusola Onigbogi
Department of Community Health and Primary Care, College of Medicine, University of Lagos, PMB 12003, Lagos
Source of Support: None, Conflict of Interest: None
Background: Substance abuse among commercial drivers in Nigeria is a major public health problem. This study was designed to determine the willingness of drivers to quit substance abuse in motor parks. Materials and Methods: A cross-sectional study was conducted among 350 commercial drivers across motor parks in Ikorodu Division of Lagos State in June 2019. Participants were selected using the multistage sampling technique, while information was obtained using an interviewer-administered questionnaire. The data were analyzed in August 2019 with univariate odds ratios (ORs) and 95% confidence intervals (95% CIs) used to determine the correlates of willingness to quit (WTQ). Results: Two hundred and eight respondents (59.4%) had engaged in substance abuse in the motor parks within the past month with most using depressants (98.1%), nonopioid pain relievers (61.1%), and stimulants (60.6%). One hundred and twenty-six respondents, that is, 60.5% of persons who had abused substances while in the motor parks. Greater WTQ was associated with road traffic crash within the past 12 months (OR = 1.33, 95% CI: 1.22–1.51), working for more than 5 days a week (OR = 1.12, 95% CI: 1.04–1.42), and existing diagnosis of a non–communicable disease (OR = 1.47, 95% CI: 1.14–1.71). Reduced WTQ was associated with lower educational status (OR = 0.82, 95% CI: 0.21–0.94) and younger age (OR = 0.31, 95% CI: 0.22–0.68). Conclusion: WTQ substance abuse in motor parks is high among the respondents. The correlates of increased or reduced WTQ should be taken into consideration when planning interventions to reduce substance abuse in motor parks.
Keywords: Abuse, commercial, drivers, substance, quit
|How to cite this article:|
Onigbogi OO, Onigbogi MO, Odugbemi TO, Ojo OY. Willingness to quit substance abuse in motor parks among commercial drivers in Lagos, Nigeria - A cross-sectional study. J Clin Sci 2021;18:8-13
|How to cite this URL:|
Onigbogi OO, Onigbogi MO, Odugbemi TO, Ojo OY. Willingness to quit substance abuse in motor parks among commercial drivers in Lagos, Nigeria - A cross-sectional study. J Clin Sci [serial online] 2021 [cited 2021 May 16];18:8-13. Available from: https://www.jcsjournal.org/text.asp?2021/18/1/8/308593
| Introduction|| |
According to the World Health Organization, substance abuse is defined as the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. According to the US Centers for Disease Control, 1.35 million people are killed on roadways around the world on an annual basis. It is estimated that 3700 people are killed on a daily basis in road traffic crashes worldwide. Road traffic injuries are estimated to be the eighth leading cause of death globally for all age groups. Road traffic injuries place a huge economic burden on low- and middle-income countries. Each year, according to a 1998 estimate, road traffic injuries cost $518 billion USD worldwide and $65 billion USD in low- and middle-income countries, which exceeds the total amount that these countries receive in development assistance.,
Road transportation is the dominant form of inland transportation and carries more than 95% of passenger traffic in Nigeria. Drivers of commercial vehicles contribute to the burden of road crashes because they spend a large proportion of their time on the roads and have the potential of putting large number of passengers and pedestrians at risk. Substance use is a known factor predisposing commercial drivers to involvement in road crashes. A systematic review of literature on drug abuse among truck drivers revealed that younger age, higher income, longer trips, alcohol consumption, driving in the night shift, long or short sleep, fewer hours of rest, little experience of the driver, connection with, and prior involvement in accidents were all contributory factors to high prevalence of reproductive tract infection (RTI) among this group. A related study in the USA on the impact of alcohol and other drugs on the trucking industry compared use with fatal-to-the-driver trucking accidents. Substances were detected in 67% of the drivers, while 33% had detectable blood concentrations of psychoactive drugs or alcohol. Cannabinoids and ethanol were the most prevalent drugs (13%), cocaine or benzoylecgonine was found in 8% of the cases, while 7% of the driver's blood specimens contained amphetamine or methamphetamine.
A study conducted among commercial drivers in Kano, Nigeria, showed that the prevalence of use of illicit substances among commercial bus drivers was 81.9%, thereby, predisposing the drivers and their passengers to health hazards. Researchers in Ilorin, Nigeria, also showed that the prevalence of mild stimulant use was 31.9% among long distance vehicle drivers in Nigeria. A study conducted in Ogun State of Nigeria among commercial vehicle drivers revealed a 47% prevalence of use of locally available alcoholic beverages in motor parks. The researchers also observed that the sale and use of cannabis in the parks was also high among the respondents. According to the study, the major determinants of substance abuse among commercial bus drivers are the desires to work hard and relieve of stress and anxiety. Previous attempts at controlling substance abuse among drivers of commercial vehicles in Nigeria have not been successful.
Precontemplation has been identified in the Transtheoretical Approach of Prochaska and DiClemente as the earliest stage of the behavioral change model. This approach was used by the same authors in determining willingness of respondents to quit cigarette smoking. Other researchers in India have tried to predict the effect of proposed interventions targeted at smokers based on their willingness to quit (WTQ). Identical methodologies have been used to determine the WTQ smoking or take extended release naltrexone among injection drug users.,,,
There is a dearth of literature on WTQ among drivers in Nigeria. However, a study conducted to determine in Ogun State revealed a high WTQ psychoactive substance use and recommended policy measures designed to ban use in public places especially in motor parks. A study examining WTQ substance use among commercial drivers has therefore become necessary in order to plan interventions that have the potential of reducing the public health burdens related to RTIs. Our study had the aim of determining the willingness of commercial drivers to quit substance abuse in motor parks. The null hypothesis is that changes observed in the correlates of WTQ substance abuse among these drivers are not due to chance and can be used in planning health education interventions in the future.
| Materials and Methods|| |
This was a cross-sectional study describing the prevalence of substance abuse among drivers in the motor parks surveyed.
The survey was conducted in Lagos which is the most populous city in Nigeria according to the 2015 census. Lagos is subdivided into five divisions comprising both urban and rural settlements. These are Ikeja, Badagry, Ikorodu, Lagos Island, and Epe divisions.
Data collection procedure
Three assistants worked with the principal investigator to administer the questions which were in English language. The assistants had a 5-h training prior to start of survey and the least educated among them had a secondary school leaving certificate.
Participants selection and sampling technique
A multistage sampling technique was used. At Stage 1, a simple random sampling technique (balloting) led to the selection of Ikorodu division out of the 5 divisions. At Stage 2, six participating motor parks were selected by simple random sampling technique from a list of forty parks which are officially recognized by the authorities. At Stage 3, in each of the motor parks, a simple random sampling method (balloting) was used to select respondents from a list of association members. Respondents were registered members of either the officially recognized transport unions, namely the National Union of Road Transport Workers, Road Transport Employers Association of Nigeria, or Lagos State Taxi Drivers and Cab Operators Association. Proportionate allocation of the number of eligible members from each of the three unions was determined based on information provided by union executives. Interviews were conducted with drivers by means of questionnaires to determine the willingness of commercial drivers to quit substance abuse within the motor parks.
Participants comprised commercial drivers who had been members of the participating unions for at least 6 months before the commencement of the survey. Only drivers who plied routes within the Lagos metropolis (inner city drivers) and had agreed to participate in the study by signing informed consent forms were included.
Nonmembers of the participating unions and those with <6 months registered membership were excluded from the study. Drivers who plied the interstate route and those who plied multiple routes were excluded.
Age (in years), marital status (single, married, others which include separated, divorced, widowed respondents), (some/completed primary education, some/completed junior secondary, some/completed senior secondary, some/completed tertiary education, type of vehicle used by respondent) (taxi, mini bus, bus, others including tricycles and motorized rickshaws, driving experience (in years), road traffic crash 12 months prior to study (yes, no), diagnosis of noncommunicable disease (yes, no), ownership of vehicle (yes, no), number of working days in a week, substance abuse in the motor park within 1 month prior to the study (yes, no), substances abused while in the motor park within the past month, reasons for substance abuse in the motor park, and WTQ substance abuse in the motor parks (yes, no). The definition of the variables were in line with that of the WHO.
Data sources and measurement
An interviewer-administered questionnaire was the instrument used for data collection.
Possibility of recall bias because some of the information required recall over the past year.
Sample size calculation
The sample size (n) was calculated using the Cochran formula as follows:
Sample size n = z2pq/d2
n = Minimum sample size required for the study
z = Normal deviate corresponding to a specified confidence level = 1.96 at 95% confidence level
p = Prevalence from prestudy estimate of proportion of illicit drug use in secondary schools = 47%
q = Estimated proportion of subjects without attribute = 1 − p = 0.53
d = Tolerable error margin (a measure of precision) = 5% = 0.05
Therefore, the calculated minimum sample size was n = 321.
The data were analyzed using Statistical Package for the Social Sciences version 17 (SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc). In August 2019. The results were presented in frequency tables. Pearson's Chi-square was used to test for association among categorical variables, while binomial and multinomial logistic regression were used to assess the strength of the association with univariate odds ratios (ORs) and 95% confidence intervals (95% CI) used to evaluate the correlates of WTQ. Bivariate and multivariate logistic regression analyses were used to determine factors associated with WTP. In order to identify the independent correlates, we used only variables that were associated with willingness at P < 0.05 in the bivariate analyses in the full multivariate model.
Ethical approval was obtained from the Health Research and Ethics Committee of the Lagos University Teaching Hospital. Permission was also obtained from the various executives of the drivers' union. The objectives, probable risks, and benefits of the outcome of the research were explained to each participant, and written informed consent was obtained before administering the questionnaires. Participants were also duly informed of the voluntariness of participation and the fact that they had the right to discontinue at any point without suffering any consequence.
| Results|| |
[Table 1] shows the sociodemographic characteristics of the participants. All of the respondents were male, with about a third of them being between 31 and 40 years of age (38.6%) and engaged in taxi driving in the parks (58.0%). More than half of the respondents had a minimum of secondary education (57.7%), majority were married (87.4%), 52.3% were of the Christian faith (52.3%), and 43.1% had between 1 and 10 years of driving experience.
Information on the prevalence and common types of substances abused in the motor parks is presented in [Table 2]. A total of 208 respondents (59.4%) reported that they had abused one form of substance while in the motor parks within a month prior to the study. Central nervous system depressants (such as alcohol, benzodiazepines, and barbiturates) were the most commonly abused substances with 204 of respondents (98.1%) reporting its use. Nonopioid pain relievers such as acetyl-salicylate and acetaminophen had also being widely used (61.1%) with stimulants such as cigarettes (nicotine) and kola nuts (caffeine) having been used by 60.6% of respondents in the parks. Opioid pain relievers (such as tramadol, codeine, and morphine) and cannabis had been abused by 21.6% and 11.1% of respondents, respectively, within the past month. The main reasons given for substance abuse while in the park were peer pressure (78.3%), stress relief (67.3%), and derivation of traditional medicinal value from concoctions consisting of alcohol (38.5%). Other reasons given include boosting of confidence (30.8%), alertness while driving (26.4%), sleep induction (25.5%), and increasing stamina (20.7%).
|Table 2: Prevalence of and reasons for substance abuse in the motor parks|
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[Table 3] shows the WTQ substance abuse while in the parks among 208 persons who had earlier reported use within the past month. One hundred and twenty-six (60.5%) indicated a WTQ.
|Table 3: Willingness of respondents to quit substance abuse in the motor parks|
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[Table 4] summarizes univariate ORs and 95% CIs for identified factors in relation to WTQ. The largest OR in relation to WTQ was the involvement of the respondent in a road traffic crash at least 12 months to the commencement of the survey. The respondent having a diagnosis of a noncommunicable disease also had significant a positive association with WTQ. Vehicle ownership by the driver and the number of working days in a week did not elicit statistically significant inferences.
|Table 4: Univariate analysis of socioeconomic factors associated with willingness to quit substance abuse in motor parks|
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[Table 5] shows the results of the correlates of WTQ substance use. Greater WTQ was associated with respondent's involvement road traffic crash within the past 12 months (OR = 1.33, 95% CI: 1.22–1.51), working for more than 5 days a week (OR = 1.12, 95% CI: 1.04–1.42), and existing diagnosis of a noncommunicable disease (OR = 1.47, 95% CI: 1.14–1.71). Reduced WTQ was associated with lower educational status (OR = 0.82, 95% CI: 0.21–0.94) and younger age (OR = 0.31, 95% CI: 0.22–0.68).
|Table 5: Multivariate analysis of factors associated with willingness to quit substance abuse in motor parks|
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| Discussion|| |
The sociodemographic profile which reveals that most respondents are in the age range 31 and 40 years and had at least some secondary school education is in line with other studies among commercial drivers in the South-western part of Nigeria.
The high prevalence of substance use by drivers in our study (59.4%) is in line with a prevalence of psychoactive substance use of 53.6%, 57.6%, and 85.4% found among commercial bus, petrol tanker, and taxi drivers, respectively, in other Nigerian studies.,, Our study revealed a high prevalence of use of stimulants, narcotic analgesics, and cannabis, while the least abused substances were the inhaled solvents, which is in agreement with the pattern of use among commercial drivers in other studies conducted in Nigeria.,,, We also found out that substance abuse at the parks was either due to the influence of peers (78.3%), relieve stress (67.3%), or desire to derive the herbal medicinal benefits of alcohol-based concoctions (38.5%). In addition, some drivers (26.4%) reported that the substances were used in order to keep them alert while on the road. These findings agree with previous surveys among drivers in Nigeria revealing the myth of the medicinal value concoctions and their ability to increase alertness while driving.,,
A relatively high level of WTQ in our study (60.5%) is identical to results from studies on WTQ smoking conducted in Korea and Holland in which researchers found a direct link between a relatively high WTQ smoking and the social environment of the smokers., In the Korean study, a total of 995 respondents were studied to determine the WTQ smoking. Of those, 74.9% (n = 745) intended to quit smoking. Univariate analyses revealed that sociodemographic factors, smoking-related beliefs, and smoking restrictions were associated with intention to quit. In the Dutch study, regression analyses were conducted with 509 smoking employees from eight worksites. Variables of interest were attitudes toward smoking, perceived social pressure to quit, and perceived smoking behavior of others. They researchers concluded that Dutch worksites and social influences stemming from people at work have some influence on employees' intention to quit smoking although this was less than the social influence from loved ones. The high level of WTQ in our study may also be linked to the existence of a law banning alcohol consumption in Lagos motor parks. The fear of potential stigmatization may have influenced the response to our questions.
Our study revealed that the age of respondents and their level of education were strong predictors of WTQ substance abuse in the parks. This is similar to results from a study to examine the correlates of alcohol use among drivers in Calabar, Nigeria, in which having a postsecondary education conferred some level of protection against alcohol use. A Finnish study reported a significant association between a low level of education and heavy alcohol use. This finding is also supported by a population-based study in Portugal, which revealed that a 10-year increase in age decreased the amount of alcohol ingested by approximately 22%.
| Conclusion|| |
The relatively high level of WTQ substance abuse by commercial drivers in the motor parks is a pointer to the fact that there is a potential of success if the existing laws on ban of the sale of certain substances of abuse in the Lagos motor parks is strictly enforced. The correlates of increased WTQ such as frequency of road traffic crashes, workload, educational status, and age of drivers should be taken into consideration while planning interventions to reduce substance abuse in motor parks. There may also be a need for qualitative studies to explore the link between substance abuse and other social factors in the motor parks.
This was a cross-sectional descriptive study conducted among a section of commercial drivers in Lagos State of Nigeria. We acknowledge that this is a limitation because the high WTQ substance abuse which we found in the motor parks may be due to a higher level of civic education in Lagos compared to other parts of the country. Furthermore, we identify the fact that we were only able to collect data based on the reports from the drivers without corroborating this with blood tests for metabolites nor conducting breath alcohol tests.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]