Using evidence to tackle student shisha and alcohol abuse

Alcohol, as the foremost psychoactive substance, presents a significant public health challenge globally. Its consumption is linked to more than 60 disease conditions and injuries, including non-communicable diseases, and is a leading risk factor for disability and premature mortality among individuals aged 15 to 49 years, according to the Global Burden of Disease Study, 2016.

Despite historically higher rates of harmful alcohol use in developed economies, African nations are witnessing a concerning trend towards increased adoption of this unhealthy lifestyle. Nigeria, in particular, ranks among the countries with the highest prevalence of current alcohol use among adults aged 15 and older, with rates ranging from 40% to 59.9% at the population level for both genders.

The escalating alcohol use in Nigeria and other Sub-Saharan African countries is exacerbated by factors such as its widespread availability, diverse production methods, the proliferation of unlicensed vendors, and lax regulations on alcohol advertising, indicating a deficiency in effective alcohol control policies.

Alcohol consumption is notably recognised as a prevalent risky behaviour among university students who exhibit higher levels of alcohol consumption compared to their non-university counterparts worldwide.

Various theories have been posited to explain this phenomenon, such as the tension reduction theory, which suggests that stressors may drive individuals to increase alcohol consumption. Alcohol consumption among university students is often driven by the perceived ability of alcohol to alleviate stress and tension, and to facilitate celebration and socialising.

Recent findings have also alluded to the role of exposure to substances in media, particularly social media, in the increased alcohol consumption among young people, including university students.

Shisha smoking: A public health concern

In a similar vein, shisha smoking has emerged as a significant public health concern. Shisha smoking involves inhaling tobacco smoke that has passed through water or other liquids after combustion and, although less prevalent than cigarette smoking, its popularity is increasing, especially among young people.

In Nigeria, available evidence indicates shisha smoking prevalence rates ranging from 3% to 7% among university students. However, shisha smoking poses significant health risks, including various cancers, reduced lung function, cardiovascular problems and adverse pregnancy outcomes.

Despite the potential health, social and economic consequences associated with shisha smoking, its prevalence among Nigerian youths, including those in the university, remains concerning.

A prevailing misconception among shisha smokers is the belief that it is less harmful than cigarette smoking, a notion perpetuated by the absence of observable gender differences in shisha smoking prevalence and its social acceptance in certain cultures. This misperception is further fuelled by the appeal of flavoured shisha tobacco, known as maassel, which enhances the taste and aroma of the smoke, making it more enticing to users, particularly university students.

The transition into independence

The elevated prevalence of alcohol and shisha consumption among Nigerian university students correlates with transitioning into an independent life outside of familial oversight and encountering social environments where drinking and smoking serve as a means of peer interaction.

Consistent findings across studies have highlighted the relationship between smoking behaviour and the prevalence of alcohol consumption and heavy drinking among university students.

Factors such as residing alone or with peers, personal history of substance use, tobacco smoking, and problematic alcohol consumption among siblings have been identified as influential in shaping individuals’ lifetime alcohol usage patterns.

Furthermore, the reduced parental control as students transition into adulthood allows them more autonomy in their lifestyle choices, including the adoption of potentially harmful habits like smoking shisha.

Unlike solitary cigarette smoking, shisha smoking is often a communal activity, fostering a sense of camaraderie. Participants reported enhanced enjoyment of their social interactions during shisha sessions, attributing it to the relaxed atmosphere and engaging activities, such as playing games, which are often part of the shisha-smoking experience.

In line with previous empirical evidence, Agberotimi (2024) conducted a survey among a sample of university students aged between 18 and 29 drawn from two universities across South West and North Central Nigeria and affirmed the contributions of factors such as living off-campus alone or with friends, academic stress, peer pressure, easy accessibility to substance, and emotional distress to alcohol and shisha consumption by university students.

The observation that living arrangements, particularly residing alone or with friends, significantly impact lifetime alcohol use and heavy drinking suggests that structured environments like family households or dormitories may serve as protective factors against alcohol-related issues. For instance, a study conducted in Australia demonstrated that students with controlled alcohol consumption exhibited alcohol-related problems at markedly lower rates compared to their uncontrolled counterparts.

Similarly, research in the United States indicated that students whose parents enforced restrictions on alcohol consumption at school demonstrated reduced alcohol intake and experienced fewer associated problems compared to students with permissive parental attitudes towards alcohol use.

Support services

Highlighting the support services that could be provided to students using shisha and alcohol in the university, many of the survey participants emphasised the need for their universities to provide robust support services to cater for the different academic, emotional, social and financial needs of the students.

Almost all the respondents opined that a concerted strategy against substance use by the university management should include periodic campaigns and sensitisation on the consequences of substance abuse. Such efforts, however, should be complemented with the provision of necessary resources to help students make informed decisions about their health and well-being.

In a similar vein, making professional counselling and welfare services available and accessible to students is a promising service that could be provided to students to help them deal with problems of alcohol and drug use. Such services will also offer opportunities to students to address various underlying psychosocial concerns that may be fuelling their unhealthy and risky behaviours such as alcohol and shisha consumption.

Apart from the provision of professional and support services to students, the importance of putting up and implementing effective strategies to address issues such as the availability of and accessibility to substances in the university community, and encouraging prosocial activities to help students channel their curiosity and energy to positive behaviours cannot be overemphasised.

Similarly, universities should embrace the inclusion of evidence-based drug prevention programmes such as life skills training and the promotion of a healthy school climate into their curriculum and events.

A multifaceted approach

In conclusion, addressing the unfolding problem of shisha and alcohol consumption in the university requires a multifaceted approach that involves collaboration among various stakeholders, including university administration, faculty, students and external partners.

While it is important to drive promising strategies, it is more important that such strategies take into consideration the prevailing psychosocial and contextual factors that are specific to each institution and the student population that may be fuelling the problem of alcohol and drug use, and address such factors accordingly.

For instance, it is recommended that university management and relevant stakeholders such as parents and host communities understand the pattern of drug use as peculiar to their immediate and broader community and collaborate with relevant practitioners in school-based drug use prevention to provide a befitting evidence-based solution to the problem.

Dr Samson Femi Agberotimi is a clinical psychologist and a university lecturer in the department of psychology at Covenant University, Ota, Nigeria. He focuses on psychosocial factors and the mental health of adolescents and young adults with a special interest in substance use and lifestyle diseases.