INFLUENCE OF ABORTION STIGMA, BEHAVIOUR PATTERN AND DISTRESS TOLERANCE ON SUBSTANCE USE AMONGST ADOLESCENTS
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INFLUENCE OF
ABORTION STIGMA, BEHAVIOUR PATTERN AND DISTRESS TOLERANCE ON SUBSTANCE USE
AMONGST ADOLESCENTS
ABSTRACT
The study
assessed the influence of abortion stigma, behaviour pattern and distress
tolerance on substance use amongst adolescents. In determining the influence of
of abortion stigma, behaviour pattern and distress tolerance on substance use
amongst adolescents, four (4) scales were used namely; Abortion stigma Scale by
Shellenberg, KM, Levandowski, B., Hessini, L. (2014), Type A behaviour scale by
(Omoluabi, 1997), Distress tolerance scale by Simon and Gaher’s (2005), and
Substance use scale by Montgomery County Court Referral Program (Court
Administered Alcohol & Drug Service Program) (2012). Participants were 217
students from three secondary schools in uyo, Akwa Ibom state. The sample for this
study included 106 males and 111 females selected using purposive sampling
technique. The design used in this study was cross sectional survey design and
statistics used for this study was a 2×2×2 analysis of variance for unequal
sample size. The result of the findings showed that abortion stigma had a
significant influence on substance use amongst adolescents [F,
(1209)=26.36,P<0.01]. Behaviour pattern exert a significant influence on
substance use amongst adolescents [F, (1209)=6.29, P<.05]. Distress tolerance
did not exert a significant effect on substance use amongst adolescents.
Therefore two of the hypothesis were accepted and one was rejected and
recommendation and suggestion for further study was also advanced.
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Adolescence is “the period of life
that starts with the biological, hormonal and physical changes of puberty and
ends at the age at which an individual attains a stable, independent role in
society", (Balocchini, Chiamenti, & Lamborghini, 2013). During
adolescence one is vulnerable to engaging in a lot of risky behaviours.
Substance abuse is one of such set of behaviours. Adolescents experience many
problems , including teen pregnancy, alcohol and drug use and violence, school
failure and eating disorders (Callaham, 2003, Stein, Jaycox, kataoka, Rhodes;
& Vestal ,2003).
Adolescence is a period when people
usually begin using substances such as alcohol and other kinds of drugs, (Chia,
et. al. 2015). Adolescence is also a period of intense brain development, and
mind-altering substances could potentially have more of an effect at this stage
compared with other age groups. The use of psychoactive substances by
adolescents has been the topic of extensive research activity over many
decades. Adolescence is also seen as a critical period both for starting to
smoke, drink or use other drugs and for experiencing more harmful consequences
as a result.
Substance use is when someone consumes
alcohol or drugs. Drug use is a broad term to cover the taking of all
psychoactive substances within which there are stages: drug-free (i.e.
non-use), experimental use, recreational use and harmful use, which is further
sub divided into misuse and dependence. This definition does not discriminate
between alcohol, tobacco, caffeine, solvents, over the counter drugs,
prescribed drugs, illicit drugs, rather it focuses on changes in the body
and/or behaviour brought about through the use of such substances. These
substances are also referred to as psychoactive drugs, meaning that they affect
the central nervous system and alter mood, thinking, perception and behaviour.
Equally, the definition makes no
distinction between the legality, social acceptability or ‘value’ of drugs.
Blanket definitions which attempt to cover these areas as well as the
substance/user/affect nexus often have weak logic underpinning their meanings,
making them vulnerable to challenge, particularly in terms of highlighting
inconsistencies. For example, if alcohol and tobacco are not defined as drugs,
what does that say about adult society which approves and endorses their use,
(not minding the health and social costs they can both incur) but disapproves
of the use of cannabis and ecstasy by young people.
The use of multiple substances,
sometimes termed poly-use, is perhaps the most disturbing. There are several
theories that can account for the clustering of substance-use behaviours. On a
biochemical level, frequent use of one substance may alter the dopamine system,
and hence the reinforcement value of substances. On a psychological level, a
positive evaluation of a used substance may generalize to other substances,
including those not consumed before. Adolescents who smoke and drink regularly
have more positive attitudes towards illicit drugs and higher odds of using
them than non-smokers who do not drink . Factors like family cohesion and
friends condoning substance use seem to have similar influences on adolescents’
indulgence in smoking, alcohol and marijuana use. Different forms of substance
use may also have a common function. For example, both alcohol and cannabis can
counter feelings of depression, and help to manage the after-effects of other
drugs .
Drinking, marijuana use and delinquent
behaviours could all serve the function of ‘maturity landmarks’, or allow the
adolescent to break societal norms.
Sensation seekers derive positive consequences from new experiences. For
some, high-risk sports provide excitement; others are inclined to experiment
with psychotropic substances. Finally, it is likely that substance-use
behaviours co-occur because they occur in the same context. In many bunks,
people drink alcohol and smoke. Expectancy-value theories, on the other hand,
state that the immediate determinants of use are substance specific. For
example, according to the theory of planned behaviour (TPB) and related models, marijuana use is
predicted by thoughts and feelings concerning marijuana use. If an adolescent
happens to use a second substance (e.g. alcohol), intra- and interpersonal
factors specific to alcohol use are the most important variables.
Within an Irish context, young
peoples' experimentation with drugs will often feature alcohol and/or tobacco,
given their prevalence and the ease of access to them. Availability
(particularly alongside curiosity), anticipation of effects, youth culture and
current fashions regarding substance use each play a role in young peoples'
experimentation with drugs. For the majority of people, experimentation is
confined to those drugs which are socially acceptable. Experimentation with
substances does not automatically lead to recreational drug use or, indeed,
dependent use and may cease once the initial motivating factors have been
satisfied.
Issues of abortion for adolescents are
embedded in the status and meaning of abortion in the country in which they are
living. Unwanted pregnancies and abortion have existed since time immemorial.
The seminal work of George Devereux in 1976 on the history of abortion around
the world points to the frequency of abortion across cultures and time.
Chinese, Greek and Roman cultures all developed systems of dealing with
unwanted pregnancies and regulating population growth in their respective
societies. The Egyptians were some of the first to create abortion techniques,
which were discussed and reported in some of their first, and our oldest,
medical texts (Devereux 1976). Today, abortion is one of the most common
gynecological experiences; perhaps the majority of women will undergo an
abortion in their lifetimes (A˚ahman and Shah 2004). Despite its existence
across time and its persistence across geographic location, the impact of
abortion on women, families, communities and societies differs drastically
across the world. Safe abortions – those done by trained providers in hygienic
settings – and early medical abortions (using medication to end a pregnancy)
carry few health risks (World health organization 2003). However, every year,
close to 20 million adolescents risk their lives and health by undergoing
unsafe abortions (Sedgh, G., S. Henshaw, S. Singh, E. Ahman, and I.H. Shah. 2007).
Twenty-five percent of these women will face a complication with permanent
consequences and close to 66,500 women will die (WHO, 2007). The majority of
these women live in the developing world and half of those who die are under
the age of 25 years (WHO 2007).
International Project Assistance
Services (Ipas) in 1978, defined abortion stigma as “negative attribute
ascribed to women who seek to terminate a pregnancy that ‘marks’ them as
inferior to ideals of womanhood.”. Abortion stigma, an important phenomenon for
individuals who have had abortions or are otherwise connected to abortion, is
under-researched and under-theorized. The few existing studies focus only on
women who have had abortions, which in the United States represents about one third
of women by age 45 (Henshaw, 1998). Kumar, Hessini, and Mitchell (2009)
recently theorized that women who seek abortions challenge localized cultural
norms about the “essential nature” of women. It is posited that abortion stigma
may also apply to medical professionals who provide abortions, friends and
family members who support abortion patients, and perhaps even to prochoice
advocates. The following questions are essential here; does abortion stigma
affect persons stemming from the same root as the victim? Do they experience
this stigma in the same way as the victim? This questions are predicated on
Kumar et al', (2009) work by exploring how different groups experience abortion
stigma and what this tells us about why abortion is stigmatized.
Silence is an important mechanism for
individuals coping with abortion stigma; people hope that if no one knows about
their relationship to abortion, they cannot be stigmatized. Nevertheless, even
a concealed stigma may lead to an internal experience of stigma and health
consequences (Quinn & Chaudior, 2009). Goffman in 1963 described stigma as
“an attribute that is deeply discrediting,” reducing the possessor “from a
whole and usual person to a tainted, discounted one.” Many have built on
Goffman’s definition over the past 45 years, a but two components of
stigmatization consistently appear across disciplines: The perception of
negative characteristics and the global devaluation of the possessor. On their
part, Kumar et al. (2009) define abortion stigma as “a negative attribute
ascribed to women who seek to terminate a pregnancy that marks them, internally
or externally, as inferior to ideals of womanhood” (p. 628, emphasis added).
Like Kumar et al. (2009), we dispute any “universality” of abortion stigma. We
retain their useful multilevel conceptualization, understanding stigma as
created across all levels of human interaction: between individuals, in
communities, in institutions, in law and government structures, and in framing
discourses (Kumar et al., 2009).
The experience of abortion stigma can
be transitory or episodic for some abortion patients. Abortion may not become a
salient part of their self-concept and may re-emerge only at key moments. For
example, a woman who rarely thinks of the abortion she had 20 years ago may
find herself face-to-face with abortion stigma when her new father-in-law
loudly asserts anti-abortion rhetoric at a holiday dinner or she may
re-experience it when she is asked about her reproductive history by her obstetrician.
Thus, caution is made against reification of individually experienced abortion
stigma as something that one always “has” or is always salient. Women who have
had abortions are a heterogeneous group (Jones et al., 2010). Their reasons for
terminating their pregnancies also vary (Finer, Frohwirth, Dauphinee, Singh,
& Moore, 2005). In public discourse and from the perspective of women
having abortions, however, the idea that there are “good abortions” and “bad
abortions” stemming from “good” and “bad” reasons for having them, is
prevalent. Stigma experienced by women who have had abortions may be mitigated
or exacerbated by whether their abortions fall into one category or the other.
“Good abortions” are those judged to be more socially acceptable, characterized
by one or more of the following: A fetus with major malformations, a pregnancy
that occurred despite a reliable method of contraception, a first-time abortion
an abortion in the case of rape or incest, a very young woman, or a contrite
woman who is in a monogamous relationship. “Bad abortions,” in contrast, occur
at later gestational ages and are had by “selfish” women who have had multiple
previous abortions without using contraception (Furedi, 2001). Women who have
had abortions may be both the stigmatizer and the stigmatized, believing they
had “good abortions” and distancing themselves from others who had “bad
abortions” (Rapp, 2000). These moral distinctions may be drawn by any woman
having an abortion, whether anti-abortion or prochoice (Arthur, 2000).
As Kumar et al. (2009) deftly
demonstrate abortion violates two fundamental ideals of womanhood: Nurturing
motherhood and sexual purity. The desire to be a mother is central to being a
“good woman”. Abortion, therefore, is stigmatized because it is evidence that a
woman has had “no procreative” sex and is seeking to exert control over her own
reproduction and sexuality, both of which threaten existing gender norms (Kumar
et al., 2009). The stigmatization adolescents experience may not be rooted in
the act of aborting a fetus; stigma may instead be associated with having
conceived an unwanted pregnancy, of which abortion is a marker. Stigma may be
associated with feelings of shame about sexual practices, failure to contracept
effectively, or misplaced faith in a partner who disappoints. Abortion can be
seen here as one of several “bad choices” about sex, contraception, or partner
(Furedi, 2001).
Behavior pattern is a recurrent way of
acting by an individual or group toward a given object or in a given situation.
Behavior pattern A is a type of personality that concerns how people respond to
stress. However, although its name implies a personality typology, it is more
appropriately conceptualized as a trait continuum, with extremes Type-A and
Type-B individuals on each end. Friedman and Rosenman (both cardiologists)
actually discovered the Type A behavior by accident after they realized that
their waiting-room chairs needed to be reupholstered much sooner than
anticipated .When the upholsterer arrived to do the work, he carefully
inspected the chairs and noted that the upholstery had worn in an unusual way:
"there's something different about your patients, I've never seen anyone
wear out chairs like this." Unlike most patients, who wait patiently, the
cardiac patients seemed unable to sit in their seats for long and wore out the
arms of the chairs. They tended to sit on the edge of the seat and leaped up
frequently. Friedman and Rosenman in 1976 labeled this behavior pattern Type A personality.
They subsequently conducted research to show that people with type A
personality run a higher risk of heart disease and high blood pressure than
people with Type B behaviour pattern.
Type A individuals tend to be very
competitive and self-critical. They strive toward goals without feeling a sense
of joy in their efforts or accomplishments .Interrelated with this is the
presence of a significant life imbalance. This is characterized by a high work
involvement. Type A individuals are easily ‘wound up’ and tend to overreact.
They also tend to have high blood pressure (hypertension).Type A personalities
experience a constant sense of time urgency: Type A people seem to be in a
constant struggle against the clock. Often, they quickly become impatient with
delays and unproductive time, schedule commitments too tightly, and try to do
more than one thing at a time, such as reading while eating or watching
television. People with Type B personality tend to be more tolerant of others,
are more relaxed than Type A individuals, more reflective, experience lower
levels of anxiety and display a higher level of imagination and creativity.
Also, Type A personality implies a
temperament which is stress prone, concerned with time management. They are
ambitious, rigidly organized, hard-working, anxious, highly status conscious,
hostile and aggressive. Type B in the other hand is one that is less prone to
stress, easy going, work steadily, enjoy achievement, modest ambition, and live
in the moment. They are social, creative, thoughtful, procrastinating. Type B
personality, by definition, are noted to live at lower stress levels. They
typically work steadily, and may enjoy achievement, although they have a
greater tendency to disregard physical or mental stress when they do not
achieve. When faced with competition, they may focus less on winning or losing
than their Type A counterparts, and more on enjoying the game regardless of
winning or losing.
Unlike the Type A personality's rhythm
of multi-tasked careers, Type B individuals are sometimes attracted to careers
of creativity: writer, counselor, therapist, actor or actress. However, network
and computer systems managers, professors, and judges are more likely to be
Type B individuals as well. Their personal character may enjoy exploring ideas
and concepts.
Scientific attention has increasingly
been focused on distress tolerance due to its potential role in the development
and maintenance of multiple forms of psychopathology, and as a trans diagnostic
clinical target for intervention/prevention programs. Distress tolerance
reflects an individual’s perceived or behavioral capacity to withstand
experiential/subjective distress related to affective, cognitive, and/or
physical states (e.g., negative affect, physical discomfort). Scholars have
therefore suggested it is an individual difference factor for stress
responsivity and psychological vulnerability. Conceptual models of distress
tolerance suggest that the construct may be hierarchical in nature.
Specifically, there may be one global “experiential distress tolerance”
constructs incorporating other, specific low order construct.
Distress intolerance in the other hand
is a perceived inability to fully experience unpleasant, aversive or
uncomfortable emotions, and is accompanied by a desperate need to escape the
uncomfortable emotions. Difficulties tolerating distress are often linked to a
fear of experiencing negative emotion. Often distress intolerance centers on
high intensity emotional experiences, that is, when the emotion is ‘hot’,
strong and powerful (e.g., intense despair after an argument with a loved one,
or intense fear whilst giving a speech).
An important thing to consider when
assessing levels of distress tolerance is that like many things in life, doing
anything at the extreme can be unhelpful. Think of distress tolerance as a
continuum where at one end people can be extremely intolerant of distress, and
at the other end people can be extremely tolerant of distress. Distress
tolerance is widely accepted to be a clinically relevant capacity to both
internalizing and externalizing symptoms ( Leyro et al., 2010). Consequently, a
negative reinforcement approach has been adopted to understand the commonality
of distress tolerance to this broader scope of psychopathology (Baker, Piper,
McCarthy, Majeskie, & Fiore, 2004). Negative reinforcement refers to the motivation
to avoid or escape negative affective states, and has typically been applied
within an addiction framework, wherein repeated substance use alleviates
distress associated with withdrawal ( Baker et al., 2004). In studies of
adults, substance-dependent individuals are reported to have lower tolerance of
distress (Quinn, Brandon, & Copeland, 1996), and distress tolerance is
related to recent abstinence duration and treatment retention among residential
treatment-seeking substance abusers ( Daughters, Lejuez, Bornovalova, et al.,
2005; Daughters, Lejuez, Kahler, Strong, & Brown, 2005).
1.2 Statement of Problem
Substance use by young people is on
the increase, and initiation of use is occurring at ever-younger ages. Patterns
of substance use over the past 20 years have been documented by two
surveys--the National Household Survey on Drug Abuse conducted by the Substance
Abuse and Mental Health Services Administration (SAMHSA) in 1998, and the
Monitoring the Future Study conducted by the National Institute on Drug Abuse
(NIDA,) in 1996.
The explosive increase in the misuse
of prescription and nonprescription medications has been referred to as
“pharming.” The term Generation Rx has been used to describe this increase in
prescription-drug misuse among the current generation of youths. In 2007, 9.5%
of adolescents aged 12 to 17 years indicated that they had used an illicit drug
(marijuana, cocaine, heroin, hallucinogens, inhalants, or psychotherapeutics
used nonmedically) within the past month. While marijuana was the most-used
illicit drug (6.7%), past-month nonmedical use of psychotherapeutics (pain
relievers, tranquilizers, stimulants, and sedatives) came in second (3.3%).
Although past-month nonmedical use of prescription medications among
adolescents declined slightly from 2002 to 2007 (4.0% and 3.3%, respectively),
this should still be an area of great concern and attention in the medical
community, (Flisher A, Parry CDH, Evan J, Muller M, Lombard C, 2003)
Drug use remains a significant problem
in the United States, however adolescent drug use is particularly damaging as
such use can affect the physical and mental development of younger people and
can impact their opportunities later in life. In 1991, approximately 30.4 percent
of those in school grades 8, 10, and 12 had used illicit drugs at some point in
their lives. This number reached a high of 43.3 percent in 1997, but dropped
back to around 33 percent in 2017. As of 2017, marijuana was still one of the
most used drugs among adolescents with around 80 percent of 12th graders
perceiving marijuana as fairly easy to obtain, compared to 27.3 percent of
those perceiving the same for cocaine .
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