Vol.3, No.6, 420-427 (2013) Open Journal of Preventiv e Me dic ine
Determinants of alcohol drinking and its association
with sexual practices among high school students in
Addis Ababa, Ethiopia: Cross sectional study
Dawit Teshome, Teferi Gedif*
Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University,
Addis Ababa, Ethiopia; *Corresponding Author: tgedif@gmail.com
Received 12 July 2013; revised 15 August 2013; accepted 30 August 2013
Copyright © 2013 Dawit Teshome, Teferi Gedif. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction: Alcohol drinking and risky sexual
practices have become serious public health
problems among teenagers and young adults
globally, including many developing countries.
The available reports are sparse, especially there
is a lack of recent and representative data for
high school students in developing countries
including Ethiopia. The aim of this study w as to
estimate the prevalence, identify determinants,
and examine the association of alcohol drinking
with sexual practices among high school stu-
dents in Addis Ababa, capital city of Ethiopia.
Methods: School-based cross sectional study
was conducted from November to December
2010. Multivariate logistic regression analysis
was used to determine the association between
students’ background characteristics and alco-
hol use, and alcohol use and sexual practices.
Results: Among 2551 students surveyed, life-
time and current (past month) alcohol drinking
were reported by 1166 (45.7%) and 676 (26.5%)
students, respectively. Having sexual inter-
course at least once in their lifetime was re-
ported by 412 (16.2%) with 151 (5.9%) of them
being sexually activ e duri ng a mon th p rior to th e
survey. Having multiple sexual partners (52.5%),
drinking alcohol before sexual intercourse
(26.4%), and having sexual intercourse without
the use of condom (47.3%) were also common
among sexually active students. In adjusted lo-
gistic regression model, age (18 and 19 and
older), living with 2 parents, getting pocket
money, having alcohol drinking friends and at-
tending general secondary school (grade 9 - 10)
were positive predictors of current alcohol
drinking. Negative predictors of current alcohol
drinking were being Protestant Christian and
living with relatives or siblings. Conclusion: Al-
cohol drinking before sexual intercourse was a
major problem among high school students in
Addis Ababa, Ethiopia. Male gender, older age
and higher school grade, friends influence, reli-
gious affiliation, living with parents and getting
pocket money were significant predictors of
current alcohol drinking. Educating about sub-
st ance use and risky sexual behaviors, engaging
students in extracurricular activities and restrict-
ing access to alcohol to high school students
may help in solution of these problems on a lo-
cal scale.
Keywords: Alcohol; Sexual Practice; High School;
Addis Ababa; Ethiopia
Current young generation especially in developing
countries including Ethiopia is confronting adulthood in
a world vastly different from previous generations. HIV/
AIDS, globalization, urbanization, electronic communi-
cation, migration, and economic challenges are among
the few [1]. More than 1.75 billion of the world’s popu-
lation is young, aged between 10 and 24 years, and often-
times thought of as healthy group [2]. However, many
risk behaviors such as physical inactivity, antisocial and
criminal behavior, and hazardous drinking [3] are often
initiated during early and late adolescence [4-7].
Harmful alcohol use is also one of the behaviours
which departs from the norms, both social and legal, of
the larger society and tends to elicit some form of social
control responses such as social rejection or even incar-
ceration [8]. Alcohol abuse is a major global contributing
Copyright © 2013 SciRes. OPEN A CCESS
D. Teshome, T. Gedif / Open Journal of Preventive Medicine 3 (2013) 420-4 27 421
factor to death, disease, and injury to the drinker. It may
also impact others (e.g. family) through the actions of
alcohol abusers. Nearly 55% of the world’s population
consumes alcohol and 2.5 million people die each year
due to the harmful effects of alcohol abuse [5].
Other common problems among regular alcohol
drinkers at early age are economic costs, violence, ab-
senteeism (in the workplace and school), early initiation
and unprotected sexual intercourse, multiple sexual
partners, unwanted pregnancy, and drug experimentation
[9-11]. These combined medical, economic, criminal,
and social impacts of abuse and addiction to alcohol,
nicotine, and illegal substances in US were estimated to
be more than half a trillion dollars a year [12]. Similarly,
more than 800 million euros was an estimated cost of
hospitalization due to alcohol use in Ireland over the five
years period (2000 to 2004) [13].
In Ethiopia, the reported prevalence of hazardous
drinking and alcohol dependence was 3% and 1.5%, re-
spectively [14]. Alcohol and khat, a stimulant drug de-
rived from the shrub (Catha edulis) that is native to East
Africa, were the most commonly used social drugs in all
high school students in Addis Ababa [15]. Studies also
reported initiation of alcohol and other drugs use [16,17]
and an increase in frequency and quantity of substance
use among teenagers and adolescents for both sexes
[18,19]. These risk behaviors are often associated with
increased risk of morbidity and mortality [3].
Overall, the type and preference of alcoholic bever-
ages consumed, the amount and frequency of alcohol
consumed per person and occasions vary greatly among
different countries and cultures, among different popula-
tion groups within a given country, and for each popula-
tion over time [20,21]. Previous studies showed that
schools, friends, families, communities, and religious af-
filiations are significant predictors of alcohol drinking
among adolescents [22-27]. Since most high school stu-
dents in Addis Ababa are within this (adolescent) age
group, they are expected to share the same problems.
Therefore, the aim of this study was to estimate the
prevalence, identify determinants, and examine associa-
tion of alcohol drinking with sexual practice among high
school students in Addis Ababa. The research findings
would help to inform the most feasible and appropriate
intervention targeted at adolescents in general and stu-
dents in particular in order to minimize risks related to
alcohol and drugs use.
2.1. Study Area
This study was conducted in Addis Ababa high
schools. At the time of the study, the projected total pop-
ulation of the city was 3,040,740 (1,448,904 male and
1,591,836 female) [28]. Nearly one third (27.5%) of the
city population were young (aged 10 - 24) [29]. At the
time of the survey, the city had 154 secondary schools
(Grade 9 - 12) owned by government, public, private,
religious organizations, non-governmental organizations
(NGOs), and foreign communities. At 2010/ 2011 school
year, 117,169 students were enrolled in all secondary
schools (grade 9 - 12). Among these, 24.1% students
were attending preparatory school (PPS) (grade 11 and
12) and the rest was attending General Secondary School
(GSS) (grade 9 and 10) students [30].
2.2. Study Design and Sampling
School-based cross-sectional survey was conducted
using a piloted self-administered anonymous question-
naire between November and December, 2010. The
study population included all grade 10 and 12 regular
students, who volunteered and consented to participation
and available at the time of data collection in selected
high schools. The European School Survey Project on
Alcohol and other Drugs (ESPAD) recommends a mini-
mum of 2400 students for school survey [31]. With the
assumption of 85% response rate (15% none or inappro-
priate responses), of the sample included 2760 students
selected using multistage cluster sampling. The partici-
pating schools were stratified into GSS and PPS based on
the education level and then stratified based on owner-
ship as government, private, public and mission owned
schools. After that, the sample size of students for each
level and type of school was determined based on pro-
portions of the total students at each school. Finally, each
school and class was selected using simple random sam-
2.3. Data Collection
The survey questionnaire was prepared based on ES-
PAD 2007 student core questionnaire [31] and available
literature [11,14,32]. It has 35 questions divided into
three major categories: background characteristics, alco-
hol use, and sexual practices. The final questionnaire was
prepared in Amharic language and piloted in a govern-
ment and a private school, which were not included in
the actual study. After pre-testing, all the necessary
modifications were made and data were collected in each
2.4. Variables
While the dependent variables were alcohol, khat, cig-
arette, shisha and cannabis use, and sexual practice of
high school students, the independent variables were age,
sex, religious affiliations, pocket money, friends and
family influence, school type and level, availability of
alcohol, khat, tobacco, cannabis and availability of ven-
ues for using substances in nearby to the residence or
Copyright © 2013 SciRes. OPEN A CCESS
D. Teshome, T. Gedif / Open Journal of Preventive Medicine 3 (2013) 420-4 27
2.5. Data Analysis
Data were entered into Epi-Info 2008 version 3.5.1
and analyzed using SPSS version 16. Multivariate logis-
tic regression model at 95% confidence interval was used
to determine the association between dependent and in-
dependent variables.
2.6. Ethical Considerations
This study was reviewed and approved by Ethics Re-
view Committee of the School of Pharmacy, Addis Ab-
aba University. In addition, consent was also obtained
from each school and the study participants.
3.1. Characteristics of the Study
A total of 2760 students from 11 GSS (grade 9 - 10)
and 4 PPS (grade 11 - 12) participated in the study. Com-
pleted 2551 (92.4%) questionnaires were used for data
analyses. The mean age was 16.93 (SD ± 1.35) years
ranging from 14 to 25 years old. Most of the students
were females (54.8%), in the age group of 16 to 17
(54.2%), GSS students (76.1%), Orthodox Christian
(75.3%), and living with both parents (57.8%) (Table 1).
3.2. Prevalence of Alcohol Drinking
Of surveyed 2551 students, 1155 (45.7%) reported
drinking alcohol at least once in their lifetime (ever use);
and 676 (26.4%) of them reported drinking alcohol 30
days (past month) prior to the survey (current users).
Both lifetime (57.1% vs. 33.4%) and current prevalence
(36.3% vs. 20.8%) rates of alcohol drinking were higher
among males than females.
Among students, 2.6% and 1.1% were lifetime users
and current user of all substances (alcohol, khat, tobacco
and cannabis), respectively. Using alcohol and khat ei-
ther concurrently or at different times were the highest
among the students with lifetime (13.6%) and current
(6.5%), followed by alcohol and cigarette (8.2% ever
user vs. 4.9% current user) and alcohol, khat and ciga-
rette use (7.6% ever user vs. 3.4% current user) (Table
3.3. Alcohol Use History
As approximately 45% (1166) students reported ever
use of alcohol. Of these, 42.9% started drinking while
attending GSS. Starting alcohol drinking in JSS (35.7%),
primary schools ( Grade 6) (15.9%) and PPS (5.5%)
were reported. Beer/draft (37.2%), wine (28.8%), and
local beer tella (26.9%) were the most commonly con-
Table 1. Socio-demographic characteristics the study partici-
pants (n = 2551).
Variable n (%)
Male 1154 (45.2)
Female 1397 (54.8)
15 334 (13.1)
16 718 (28.1)
17 666 (26.1)
18 545 (21.4)
19 288 (11.3)
Orthodox Christian 1922 (75.3)
Muslim 285 (11.2)
Protestant Christian 285 (11.2)
Others* 59 (2.3)
Marital Status (n = 2550)
Never Married 2534 (99.3)
Married/Divorced 16 (0.7)
Live with (n = 2007)
Both parents 1477 (57.8)
Single parent 530 (20.8)
Guardian/Orphan centre 40 (1.6)
Relatives or siblings 431 (17.0)
Alone 61 (2.4)
Others# 9 (0.4)
Class level of education
PPS 611 (24)
GSS 1940 (76)
*Jehovah witness, pagan/atheist, Catholic Christian, #living with husband/
wife, employer.
Table 2. Prevalence of multiple substance use among the study
participants (n = 2551).
30 days
Substance used
n (%) n (%)
Alcohol, Cigarette, Khat, Shisha
& Cannabis 66 (2.6) 28 (1.1)
Alcohol, Cigarette, Khat &
Shisha 113 (4.4) 45 (1.7)
Alcohol, Cigarette, Khat &
Cannabis 83 (3.2) 37 (1.4)
Alcohol, Cigarette & Khat 195 (7.6) 87 (3.4)
Alcohol & Cigarette 265 (10.3) 126 (4.9)
Alcohol & Khat 349 (13.6) 167 (6.5)
Alcohol & Shisha 196 (7.5) 109 (4.3)
Alcohol & Cannabis 109 (4.3) 64 (2.5)
Alcohol, Cigarette & Shisha 126 (4.9) 52 (2.0)
Alcohol, Cigarette & Cannabis 97 (3.8) 46 (1.8)
Copyright © 2013 SciRes. OPEN A CCESS
D. Teshome, T. Gedif / Open Journal of Preventive Medicine 3 (2013) 420-4 27 423
sumed alcohol beverages. Consumption of other alco-
holic beverages (7.1%) such as local drink tej, whisky,
gin and local liquor areke were also reported. Higher
proportions of males compared to females reported
drinking of all kinds of alcoholic beverages except wine.
Holidays (42.7%) were the most common events/oc-
casions for current alcohol drinkers. Drinking during the
weekdays particularly in the evening (36.9%) and on
weekends (13.3%) was also customary. In addition,
11.2% of current alcohol drinkers reported drinking al-
cohol regardless of a day or time as long as they have
had the opportunity.
Among the current alcohol users (n = 676) during the
last month, 84.8% drunk on 1 to 5 days, 13.6% drunk on
6 to 29 days, and 1.6% drunk on all 30 days (daily). Most
students reported drinking with their friends (42.9%),
families (41.6%) and fiancé (6.2%). Interestingly, 0.1%
students reported drinking alcohol with commercial sex
workers (bar ladies) in a pub or a bar.
More than half of the students reported drinking in
their friends’, relatives’ and own home (52.1%) while the
rest reported drinking in bars (19%), kiosks (14%), res-
taurants (8%), other places (7%) such as party, school, or
traditional drink shop tella bet. Relaxation (75.4%) was
students’ main reason for drinking alcohol followed by
family/friends influence (10%). Drinking alcohol to
avoid stress (7.2%), after chewing khat, to promote
health, for experimentation, being addicted, to facilitate
digestion (after having a heavy meal), and to treat minor
stomach ailments especially with local liquor areke
(7.4%), were also common.
Nearly three fourth (74.8%) of students reported that
after drinking alcohol they were taking rest at home
while others hang out with friends (21.1%), smoked cig-
arettes (4%), or had sexual intercourse (3.8%). Other
behaviors reported by some students (4.4%) were crying,
quarrelling with peoples, and smoking cannabis.
3.4. Sexual Practice and Alcohol
Among students, 412 (16.2%) and 151 (5.9%) re-
ported having been engaged in sexual intercourse at least
once in their lifetime and during the past month, respec-
tively. Students’ sexual experience varied with gender.
More males than females reported having lifetime
(26.3% vs. 8.9%) and current (7.7% vs. 3.4%) sexual
intercourses. Unexpectedly, 12.7% of students reported
having sexual intercourse at young age ( grade 6).
Among the students who had sexual intercourse at least
once (n = 412), more than half (52.5%) had more than
one sexual partners. Almost half students (47.3%) re-
ported having sex without using a condom at least once
in their lifetime.
Of the currently sexually active students (n = 407),
26.4% drunk alcohol, 7.5% chewed khat, 4.4% smoked
cigarettes, 1.8% smoked cannabis, and 1.3% smoked
shisha before a sexual intercourse.
3.5. Determinants of Alcohol Use and Its
Association with Sexual Practices
The odds of current alcohol use were more common
among students aged 18 [AOR = 2.028; CI (1.157 -
3.557)] or 19 years or older [(AOR = 2.520; CI (1.339 -
4.743)] than those aged 15 years. GSS students were
more likely to drink alcohol than PPS students [AOR =
1.811; CI (1.305 - 2.513)]. Getting pocket money [AOR
= 1.457; CI (1.118 - 1.898)], having shisha smoking
family members [AOR = 2.259; CI (1.194 - 4.274)] or
friends [AOR = 1.857; CI (1.178 - 2.929)], having
friends who drink alcohol [AOR = 1.724; CI (1.248 -
2.380)] were significant predictors of current alcohol use.
Being current alcohol user was positively associated with
current sexual practice among students [(AOR = 2.260;
CI (1.282 - 3.985)].
Factors negatively associated with current alcohol use
presented in Tables 3 and 4 were being Protestant Chris-
tian [AOR = 0.629; CI (0.432 - 0.918) and living with
relatives/siblings [AOR = 0.466; CI (0.255 - 0.851).
Our study is the newest among a few studies that re-
ported lifetime and current prevalence of alcohol drink-
ing, multiple substance use and sexual experiences
among Addis Ababa high school students. In addition,
we examined the association between socio-demographic
variables and current alcohol drinking practices, and al-
cohol use and sexual practices. Although this study has
several unique features, it has also some limitations. First,
we did not address binge drinking behavior; second, self
reported nature the survey might result in inaccurate re-
porting in culturally sensitive issues such as khat use,
sexual intercourse/activity or substance use. The results
of the study also cannot be generalized to all adolescents
since those not attending school may differ from in-
school adolescents.
The prevalence of current alcohol use documented in
this study was higher than other similar studies con-
ducted in Harar province in Ethiopia, Thailand and Zim-
babwe, where the current prevalence reported were be-
tween 9.5% and 12.17% [33-35]. However; the preva-
lence was lower than in high school students in Georgia
(40%), USA (44.9%), Japan (44.0%), Turkey (46%) and
Nigeria (78.4%) [36-40]. The observed variation in pre-
valence estimates might be due to difference in culture,
geographical location, alcohol use in general population,
acceptance of alcohol use, and alcohol advertisement
among the countries. Other causes of differences among
studies could be related to methodology such as ques-
tionnaire used and sample selection and size. Nev-
Copyright © 2013 SciRes. OPEN A CCESS
D. Teshome, T. Gedif / Open Journal of Preventive Medicine 3 (2013) 420-4 27
Tab le 3. Association of 30 days alcohol use and selected socio
demographic characteristics of high school students in Addis
Ababa, November 2010.
30 days Alcohol use
Va riab l e COR (95% CI) AOR (95% CI)
Male 1.058 (0.837 - 1.338) 0.859 (0.659 - 1.118)
Female 1.00 1.00
15 1.00 1.00
16 0.509 (0.309 - 0.843) 1.311 (0.789 - 2.178)
17 0.746 (0.511 - 1.089) 1.342 (0.800 - 2.249)
18 0.780 (0.537 - 1.132) 2.028* (1.157 - 3.557)
19 0.978 (0.665 - 1.439) 2.520* (1.339 - 4.743)
Orthodox 1.00 1.00
Muslim 0.893 (0.521 - 1.528) 0.720 (0.375 - 1.379)
Protestant 0.567 (0.333 - 0.965) 0.466* (0.255 - 0.851)
Others 0.996 (0.497 - 1.995) 1.133 (0.526 - 2.441)
Students living with
Two parent 1.00 1.00
Single parent 1.095 (0.822 - 1.459) 0.874 (0.637 - 1.198)
Relatives 0.738 (0.527 - 1.033) 0.629* (0.432 - 0.918)
Others 1.109 (0.667 - 1.843) 0.796 (0.452 - 1.401)
Pocket Money
Yes 1.480 (1.163 - 1.884) 1.457* (1.118 - 1.898)
No 1.00 1.00
Academic status
80% - 100% 1.00 1.00
60% - 79% 1.412 (1.063 - 1.876) 1.304 (0.956 - 1.778)
59% 1.922 (1.129 - 3.271) 1.610 (0.904 - 2.865)
School level
PPS 1.00 1.00
GSS 1.058 (0.810 - 1.382)) 1.800* (1.230 - 2.634)
School Type ownership
Government 1.00 1.00
Mission 0.621 (0.345 - 1.116) 0.749 (0.381 - 1.469)
Private 1.016 (0.762 - 1.355) 0.856 (0.610 - 1.201)
Public 1.270 0(.875 - 1.842) 1.173 (0.778 - 1.768)
*P < 0.05, COR = Crude odds ratio; AOR = adjusted odds ratio; CI,
confidence interval.
ertheless, the prevalence rates of alcohol use found in
this study were consistent with WHO report that indi-
cates relatively lower alcohol consumption among Afri-
can high school students [5].
Lifetime (16.2%) and last-month (5.9%) prevalence of
sexual intercourse found in our study is difficult to com-
Table 4. Association of having substance using family and
close friends with current alcohol drinking of high school stu-
dents in Addis Ababa, November 2010.
30 days Alcohol use
COR (95% CI) AOR (95% CI)
Alcohol drinking
Yes 1.334* (1.056 - 1.684) 1.088 (0.826 - 1.435)
Family No 1.00 1.00
Close Friends
Yes 2.329* (1.836 - 2.954) 1.811* (1.305 - 2.513)
No 1.00 1.00
Cigarette smoking
Yes1.255 (0.911 - 1.729) 1.115 (0.739 - 1.683)
Family No 1.00 1.00
Close Friends
Yes 1.986* (1.549 - 2.548) 1.045 (0.689 - 1.584)
No 1.00 1.00
Khat chewing
Yes1.172 (0.893 - 1.538) 0.753 (0.520 - 1.091)
Family No 1.00 1.00
Close Friends
Yes 2.167* (1.696 - 2.769) 1.017 (0.672 - 1.539)
No 1.00 1.00
Shisha smoking
Yes 2.508* (1.547 - 4.067) 2.259* (1.194 - 4.274)
Family No 1.00 1.00
Close Friends
Yes 2.657* (1.998 - 3.534) 1.857* (1.178 - 2.929)
No 1.00 1.00
Cannabis smoking
Yes1.537 (0.764 - 3.090) 0.597 (0.242 - 1.472)
Family No 1.00 1.00
Close Friends
Yes 2.145* (1.533 - 3.000) 1.090 (0.656 - 1.809)
No 1.00 1.00
*P < 0.05, COR = Crude odds ratio; AOR = adjusted odds ratio; CI,
confidence interval.
pare with other reports from African countries since
not many studies have been reported. In a study con-
ducted in Zambia, past year prevalence rate of sexual
intercourse among in-school adolescents was. 13.4% [41]
which is comparable to our findings between with. The
difference could be due to the variation in the interval of
data collection period. In our study we asked for both,
lifetime and 30 days recall period while study in Zambia
used one year recall period. Cultural variation between
two countries may also explain the difference in preva-
Copyright © 2013 SciRes. OPEN A CCESS
D. Teshome, T. Gedif / Open Journal of Preventive Medicine 3 (2013) 420-4 27 425
In this study we found an association initiation of al-
cohol drinking with sexual practices. Majority of stu-
dents started drinking alcohol and practicing sexual in-
tercourse at early age while attending GSS school
(42.9% began drinking alcohol and 46.2% began sexual
intercourse) and JSS (35.7% began drinking alcohol and
31.3% began sexual intercourse). According to the Min-
istry of Education of Ethiopia [42], the average age for
alcohol drinking initiation for GSS and JSS students is
15 to 16 and 13 to 14 years, respectively. These ages are
close to alcohol initiation age reported in Japan i.e. 13
years [37] but lower compared to high school students in
Harar, Ethiopia (17.5 years) [33]. Wide cultural accep-
tance and availability of home brewed alcoholic bever-
ages particularly during holidays might contribute for
early alcohol exposure to sizable proportion of students.
Studies also showed that early initiation of alcohol
drinking and sexual exposure, and substance use prior to
sexual intercourse and are likely cause of unintended
pregnancy. Other consequences include involvement in
risky sexual behavior such as unprotected vaginal sex,
having multiple sexual partners, and increased risk for
sexually transmitted disease including HIV/AIDS. Such
risky behaviors might often continue through mid-ado-
lescence and later [9,11,18].
We found that as reported in other studies [40,43], re-
laxation, influence of friends and family were the major
motives for alcohol drinking. The common alcohol
drinking after khat chewing often reported in this study
might have reduced stimulation caused by cathinone
from khat and allowed falling asleep especially at night.
Similar behavior was reported by other studies [44,45].
The current alcohol drinking practice in all students
was strongly associated with getting pocket money, and
having close friends and family who are current sub-
stances users. Previous studies conducted in various set-
tings also reported similar findings [35,46,47].
The GSS students were twice more likely than PPS
students to be current alcohol drinkers. The transition
from JSS to GSS usually requires attending a new school
(especially in government-run school system) and adap-
tation to a new environment. These factors change might
also contribute to either initiation of alcohol use or be-
come a current alcohol drinker [48]. Maturity of students
may have protective effect for PPS. Interesting finding
that protestant faith followers were less likely to be cur-
rent alcohol drinkers compared to orthodox Christians
require further studies. Perhaps religions with more con-
servative view about alcohol use may have protective
effect against risky behaviors as reported earlier [49].
Alcohol drinking among high school students in Addis
Ababa is a major public health concern with lifetime and
current prevalence of 45.7% and 26.5%, respectively.
High-risk sexual behavior such as not using a condom,
multiple sexual partners and substance use prior to sex-
ual intercourse was also common. Current alcohol
drinking was associated with age, religion, living with
(cohabiting) type, school level, pocket money and having
family and close friends who use substances. Educating
the adverse outcomes of alcohol drinking and other sub-
stances through Medias and in schools curriculum is
recommended. In addition, expanding safe recreational
place, engaging students in extracurricular activity and
regulating the sale of alcohol for the underage would be
beneficial to minimize the risk of alcohol drinking.
We would like to kindly acknowledge the study participants in Addis
Ababa High school who enthusiastically participated in this study for
their time and for sharing us their experiences. We also extend our
appreciation to school directors, and counseling and guidance office for
facilitating the session. Financial and material support for the study was
made available by the School of Pharmacy, Addis Ababa University,
Addis Ababa University MARCH Project and AIDS Resource Center.
[1] Fatusi, A.O. and Hindin, M.J. (2010) Adolescents and
youth in developing countries: Health and development
issues in context. Journal of Adolescence, 33, 499-508.
[2] WHO (2011) Adolescent health.
[3] McCarthy, W.J., Mistry, R., Lu, Y., Patel, M., Zheng, H.
and Dietsch, B. (2009) Density of tobacco retailers near
schools: effects on tobacco use among students. American
Journal of Public Health, 99, 2006-2013.
[4] DuRant, R.H., Smith, J.A., Kreiter, S.R. and Krowchuk,
D.P. (1999) The relationship between early age of onset
of initial substance use and engaging in multiple health
risk behaviors among young adolescents. Archives of Pe-
diatrics & Adolescent Medicine, 153, 286–291.
[5] WHO (2011) Global status report on alcohol and health.
World Health Organization, Geneva.
[6] Garretsen, H.F., Bongers, I.M., van Oers, J.A. and van de
Goor, L.A. (1999) The development of alcohol consump-
tion and problem drinking in Rotterdam 1980-1994: More
problem drinking amongst the young and the middle aged.
Alcohol, 34, 733-40. doi:10.1093/alcalc/34.5.733
[7] Kim, J.H., Lee, S., Chow, J., Lau, J., Tsang, A., Choi, J.
and Griffiths, S.M. (2008) Prevalence and the factors as-
sociated with binge drinking, alcohol abuse, and alcohol
dependence: A population-based study of Chinese adults
in Hong Kong. Alcohol, 43, 360-370.
Copyright © 2013 SciRes. OPEN A CCESS
D. Teshome, T. Gedif / Open Journal of Preventive Medicine 3 (2013) 420-4 27
[8] Donovan, J.E. (2005) Problem behaviour theory. In:
Flisher, C.B. and Lerner, R.M. Eds., Encyclopedia of Ap-
plied Development Science. 2nd Edition, Thousand Oaks,
Sage, 872-877.
[9] Bellis, M.A., Hughes, K., Calafat, A., Juan, M., Ramon,
A., Rodriguez, J.A., Mendes, F., Schnitzer, S. and Phil-
lips-Howard, P. (2008) Sexual uses of alcohol and drugs
and the associated health risks: A cross sectional study of
young people in nine European cities. BMC Public Heal th ,
8, 155. doi:10.1186/1471-2458-8-155
[10] Best, D., Rawaf, S., Rowley, J., Floyd, K., Manning, V.
and Strang, J. (2000) Drinking and smoking as concurrent
predictors of illicit drug use and positive drug attitudes in
adolescents. Drug and Alcohol Dependence, 60, 319-321.
[11] Stueve, A. and O’Donnell, L.N. (2005) Early alcohol
initiation and subsequent sexual and alcohol risk behav-
iors among urban youths. American Journal of Public
Health, 95, 887-893. doi:10.2105/AJPH.2003.026567
[12] NIDA (2010) The science of addiction—Drugs, brains
and behaviours. NIH Pub No. 10-5605.
[13] Martin, J., Barry, J. and Skally, M. (2011) Alcohol attrib-
utable hospitalisations and costs in Ireland, 2000-2004.
Irish Medical Journal, 104, 140-144.
[14] Fekadu, A., Alena, A. and Hanlon, C. (2007) Alcohol and
drug abuse in Ethiopia: Past, present and future. African
Journal of Drug & Alcohol Studies, 6, 39-53.
[15] Kassaye, M., Sherief, H., Fissehaye, G. and Teklu, T.
(1999) “Drug” use among high school students in Addis
Ababa and Butajira. Ethiopian Journal of Health Devel-
opment, 13, 101-106.
[16] Carter, M., McGee, R., Taylor, B. and Williams, S. (2007)
Health outcomes in adolescence: associations with family,
friends and school engagement. Journal of Adolescent
Health, 30, 51-62. doi:10.1016/j.adolescence.2005.04.002
[17] Bishop, D.I., Weisgram, E.S., Holleque, K.M., Lund, K.E.
and Wheeler-Anderson, J.R. (2005) Identity development
and alcohol consumption: Current and retrospective self-
reports by college students. Journal of Adolescent Health,
28, 523-533. doi:10.1016/j.adolescence.2004.10.007
[18] Sychareun, V., Thomsen, S., Faxelid, E. (2011) Concur-
rent multiple health risk behaviors among adolescents in
Luangnamtha province, Lao PDR. BMC Public Health,
11, 1-10. doi:10.1186/1471-2458-11-36
[19] Poelen, E.A.P., Scholte, R.H.J., Engels, R.C.M.E., Boom-
smab, D.I. and Willemsen, G. (2005) Prevalence and
trends of alcohol use and misuse among adolescents and
young adults in the Netherlands from 1993 to 2000. Drug
& Alcohol Dependence , 79, 413-421.
[20] Ahlström, S.K. and Österberg, E.L. (2005) International
perspectives on adolescent and young adult drinking. Al-
cohol Research and Health, 28, 258-268.
[21] Bennett, L.A., Campillo, C., Chandrashekar, C.R. and
Gureje, O. (1998) Alcoholic beverage consumption in In-
dia, Mexico, and Nigeria: A cross-cultural comparison.
Alcohol Health and Research World, 22, 243-252.
[22] Benjet, C., Borges, G., Medina-Mora, M.E., Blanco, J.,
Zambrano, J., Orozco, R., et al. (2007) Drug use oppor-
tunities and the transition to drug use among adolescents
from the Mexico City Metropolitan Area. Drug & Alco-
hol Dependence, 90, 128-134.
[23] Andersen, A., Holstein, B.E. and Due, P. (2007) School-
related risk factors for drunkenness among adolescents:
Risk factors differ between socio-economic groups.
European Journal of Public Health, 17, 27-32.
[24] Hung, C.C., Yen, L.L. and Wu, W.C. (2009) Association
of parents’ alcohol use and family interaction with the ini-
tiation of alcohol use by sixth graders: A preliminary
study in Taiwan. BMC Public Health, 9, 172.
[25] Fothergill, K.E. and Ensminger, M.E. (2006) Childhood
and adolescent antecedents of drug and alcohol problems:
A longitudinal study. Drug & Alcohol Dependence, 82,
61-76. doi:10.1016/j.drugalcdep.2005.08.009
[26] Brooks, F.M., Magnusson, J., Spencer, N. and Morgan, A.
(2012) Adolescent multiple risk behaviour: An asset ap-
proach to the role of family, school and community.
Journal of Public Health (Oxford), 34, i48-i56.
[27] Becerra, D. and Castillo, J. (2011) Culturally protective
parenting practices against substance use among adoles-
cents in Mexico. Journal of Substance Use, 16, 136-149.
[28] CSA (2012) Ethiopia statical annual abstarct 2011.
[29] Central Statistical Agency of Ethiopia (2008) Summary
and statistical report of the 2007 population and housing
census: Population size by age and sex. Federal Democ-
ratic Republic of Ethiopia Population Census Commis-
[30] Addis Ababa Education Bureau (2010) Education statis-
tics annual abstract 2008/09. Addis Ababa: Educational
management information system (EMIS)—Study, plan
and budget support process city government.
[31] ESPAD (2008) Methodology.
[32] Berhane, Y. and Worku, A. (2007) Alcohol and Khat con-
sumption and the association with HIV/AIDS prevention,
care and treatment in Ethiopia: Final report. Addis Conti-
nental Institute of Public Health.
[33] Reda, A., Moges, A., Wondmagegn, B. and Biadgilign, S.
(2012) Alcohol drinking patterns among high school stu-
dents in Ethiopia: A cross-sectional study. BMC Public
Health, 12, 1-6. doi:10.1186/1471-2458-12-213
[34] Rudatsikira, E., Maposa, D., Mukandavire, Z., Muula,
A.S. and Siziya, S. (2009) Prevalence and predictors of
illicit drug use among school-going adolescents in Harare,
Zimbabwe. Annals of African Medicine, 8, 215-220.
[35] Chaveepojnkamjorn, W. and Pichainarong, N. (2011)
Current drinking and health-risk behaviors among male
Copyright © 2013 SciRes. OPEN A CCESS
D. Teshome, T. Gedif / Open Journal of Preventive Medicine 3 (201 3) 420-427
Copyright © 2013 SciRes. OPEN A CCESS
high school students in central Thailand. BMC Public
Health, 11, 233. doi:10.1186/1471-2458-11-233
[36] Sturua, L., Baramidze, L., Gamkrelidze, A. and Galdava,
G. (2010) Alcohol use in Georgian students; pilot study
rigorously following criteria of European school project
on alcohol and other drug. Georgian Medical News, 179,
[37] Shimane, T. and Wada, K. (2007) Substance use among
night high school students in Japan. Nihon Arukoru Ya-
kubutsu Igakkai Zasshi, 42, 152-164.
[38] Miller, J.W., Naimi, T.S., Brewer, R.D. and Jones, S.E.
(2007) Binge drinking and associated health risk behave-
iors among high school students. Pediatrics, 119, 76-85.
[39] Alikasifoglu, M., Erginoz, E., Ercan, O., Uysal, O., Al-
bayrak-Kaymak, D. and Ilter, O. (2004) Alcohol drinking
behaviors among Turkish high school students. The Tur-
kish Journal of Pediatrics, 46, 44-53.
[40] Chikere, E.I. and Mayowa, M.O. (2011) Prevalence and
perceived health effect of alcohol use among male under-
graduate students in Owerri, South-East Nigeria: A de-
scriptive cross-sectional study. BMC Public Health, 11,
118. doi:10.1186/1471-2458-11-118
[41] Siziya, S., Muula, A.S., Kazembe, L.N. and Rudatsikira,
E. (2008) Harmful lifestyles’ clustering among sexually
active in-school adolescents in Zambia. BMC Pediatrics,
8, 6. doi:10.1186/1471-2431-8-6
[42] Minstry of Education (MoE) (2009) Ethiopia-education
[43] Madu, S.N. and Matla, M.Q. (2003) Illicit drug use, ciga-
rette smoking and alcohol drinking behaviour among a
sample of high school adolescents in the Pietersburg area
of the Northern Province, South Africa. Journal of Ado-
lescence, 26, 121-136.
[44] Ihunwo, A.O., Kayanja, F.I. and Amadi-Ihunwo, U.B.
(2004) Use and perception of the psychostimulant, khat
(Catha edulis) among three occupational groups in south
western Uganda. East African Medical Journal, 81, 468-
473. doi:10.4314/eamj.v81i9.9223
[45] Gelaw, Y. and Haile-Amlak, A. (2004) Khat chewing and
its socio-demographic correlates among the staff of
Jimma University. Ethiopian Journal of Health Develop-
ment, 18, 179-184.
[46] Rudatsikira, E., Dondog, J., Siziya, S. and Muula, A.S.
(2008) Prevalence and determinants of adolescent ciga-
rette smoking in Mongolia. Singapore Medical Journal,
49, 57-62.
[47] Denny, S.J., Robinson, E.M., Utter, J., Fleming, T.M.,
Grant, S., Milfont, T.L., et al. (2011) Do schools influ-
ence student risk-taking behaviors and emotional health
symptoms? Journal of Adolescent Health, 48, 259-267.
[48] Brian, K.B. and Joseph, A.O. (2004) Assessing the transi-
tions to middle and high school. Journal of Adolescent
Research, 19, 3-30. doi:10.1177/0743558403258113
[49] Gnadt, B. (2006) Religiousness, current substance use,
and early risk Indicators for substance abuse in nursing
students. Journal of Addictions Nursing, 17, 151-158.