Perceptions of adolescent students about drugs

Objective: To analyze the perceptions of adolescent public school students about drugs. Method: Qualitative approach of focus groups with 16 adolescent students. The data collected were analyzed by means of content analysis, leading to the following categories: meaning of drugs; living with drug use; opinions, beliefs and attitudes toward drug use; and preventing drug abuse in adolescence. Results: The adolescent students know about some drugs, and associate their use with delinquent and criminal behavior. The students identifi ed factors that lead to drug abuse, such as easy access, use by family and friends, idleness, dropping out of school and the characteristic vulnerability of adolescence. Conclusion: the results point to the need for educational activities in the context of where the adolescents live, including school, community and family environments, to support and to minimize their vulnerability.


INTRODUCTION
The use of illicit drugs is a serious public health problem in developed and developing countries (1) , being related to crime and urban violence (2) . Risk factors for drug use involve interpersonal, cultural, biological and psychological aspects/factors (1)(2) .
Regular drug use increases the likelihood of addiction. Effects of addiction include harmful consequences to mental health (3)(4) . Chemical dependency affects users and their relationships with the world, their families, and friends, with harmful consequences to studies, work, friendships and especially self-esteem (5) .
Brazilian studies such as the National Study on Student Health (PeNSE) (6) and the VI National Survey on Psychotropic Drug Use (7) showed that drug use usually starts in adolescence, with the possibility of irreversible damage in the future.
Results of the PeNSE study showed significant and worrying data on drug use among Brazilian school children, such as experimentation with alcohol (71.4%); regular consumption of alcohol (27.3%); drunkenness in life (22.1%); family concern when students come home drunk (93.8%); violence from alcohol (9.0%); cigarette smoking (24.2%) and experimenting with other drugs (8.7%). The drug phenomenon is evidenced daily in the media. To stimulate consumption, industry uses marketing that associates licit drugs with a life of satisfaction and pleasure, thereby contributing to the high prevalence of drug use in this age group. This phenomenon is augmented by students' ease of acquisition in social environments such as bars, nightclubs, concerts, stadiums and even their homes (8) . According to these studies, rates of drug use among adolescents in Brazil are worrying.
Although risk factors associated with drug use are widely studied and known, the contexts and social aspects of initiation into, and maintenance of, drug use during adolescence are not. This study is important because it seeks to know how teenagers perceive drugs and reveals aspects related to influences and experimentation that lead to early use, as well as more effective actions to minimize this situation. Thus, the aim of this study was to learn the understanding of adolescent students regarding drugs within a social context.

METHOD
This study was developed using a qualitative approach, in the social and strategic research modality (9) . Data were collected by means of focus groups (FG), a research technique applicable to the field of health care because it seeks information and to understand attitudes, beliefs, perceptions and behaviors (10) .
The FGs consisted of meetings in one place during a certain period, conducted with a small number of participants, and with the presence of a coordinator or moderator and notetaker. The FG participants were selected because they had common features associated with the study topic (10) .
The main feature of the FG is to work with the thoughts expressed in participants' statements, enabling them to simultaneously present their perceptions, impressions and ideas about a particular topic (10) .
Research was undertaken in two basic education schools (state and municipal), both located in northwest Goiânia, in a peripheral urban area with low social development index, the city's largest pocket of poverty, high rate of deaths from violent causes, and high rates of drug trafficking with worrisome indicators of mortality, all reasons that motivated undertaking the study in this region.
Study participants included 16 adolescents of both sexes who met specific criteria, including being aged between 12 and 19 years (2) , enrolled in the daytime study shift between the 6th and the 9th grades of basic education, in one of the selected schools. Two FGs of eight adolescents each were formed, with one in each school. Four meetings with each FG were held, totaling eight meetings, which were sufficient to meet the research objectives and data saturation.
A script with guiding questions was followed, which covered knowledge about drugs, motivations and influences to use, and possibilities for preventive actions. The meetings were held at the schools at times defined by the school directorship and coordination, without changing the schedule of classes and school activities. Data collection occurred in weekly meetings during a two-month period.
The meetings lasted about 60 minutes and used the following guiding questions: What do you know about drugs? How do you regard drug use? What causes a person to use drugs? What do you think should be done about drug use?
The meetings were audio recorded with participants' permission, and then transcribed and analyzed by means of thematic content analysis (11) . The material obtained from the transcripts was organized at three different times: preanalysis, exploration of the material and processing of results (11) .
The themes that emerged were grouped into thematic categories. Analysis of the material (inferences and interpretation) was based on using a theoretical framework of various areas of knowledge related to drug use, and recent studies on drugs and adolescence. At the end of analysis, four themes were identified: the meaning of drugs; living with drug use; opinions, beliefs and attitudes toward drug use; and preventing drug abuse in adolescence. Analysis of the concepts will be exemplified by some excerpts from the transcripts obtained in the FGs, based on the central category.
For identification of excerpts of statements presented in discussion, an alphabetical code (letter A for student), followed implementación de actividades educativas en el contexto en que los adolescentes viven como la escuela, la comunidad y la familia para apoyar y para minimizar los efectos de diversas vulnerabilidades de los adolescentes estudiantes. Palabras clave: Adolescente; Drogas Ilícitas; Bebidas Alcohólicas; Promoción de la Salud; Salud Escolar. by an Arabic number (1; 2; 3...) was adopted, which refers to the chronological order of the interviews and protects participants' identities.
The study adhered to the ethical precepts of the National Health Council Resolution No. 196/96, and was approved by the Research Ethics Committee of the Federal University of Goiás (No. 214/11). Research began after submission of the free and informed consent form, signed by participants' parents and/or guardians.

RESULTS
To facilitate understanding of the study subjects' perceptions of drugs, the presentation of the results considered the thematic categories.
In general, the participants' statements contextualized the understanding that adolescents have regarding use of alcohol, tobacco, and other drugs. In addition, their statements revealed understanding of the theme based on the meanings that drugs assume in the context of adolescence. These aspects are strongly present in the categories listed below.

"Meaning of drugs"
In this first category, the students' superficial knowledge about drugs was revealed. Three axes for the meaning of drugs were noted: the first relates drug use to disease; the second to crime; and the third exhibits a moralistic slant to the issue. Hence, the use of drugs means, for the group, disease, crime or immorality. The following statements portray this issue. "Living with drug use" The adolescents' statements revealed that in the everyday life of the neighborhood, situations involving the routine use of drugs and drug trafficking are common. The study participants cited several examples of involvement of other adolescents with selling drugs, the large availability of drugs in the region where they live, and that drug dealers and users do not change the routine of the neighborhood; instead, everything is regarded as natural, as evidenced in the following excerpts. The participants' statements illustrate how drugs are naturally present in the reality of the neighborhood, and the knowledge that this reality can contribute to social disorganization.
Although prohibited to be sold to minors, legal drugs such as cigarettes and alcohol are very accessible to adolescents. This fact is expressed in the following statements. The statements above reveal signs of neglect and abandonment, physical abuse and lack of family dialogue. The practice of drug use especially by family members such as parents, siblings and relatives is evidenced, a fact also present in other studies (12)(13) , in addition to contributing to early initiation to use.
"Opinions, beliefs and attitudes toward drug use" This category explores the adolescents' opinions, curiosity, influences and experimentation with drugs.
Adolescence is viewed by the participants as a critical and fragile phase, which entails challenges and questioning of authority, and above all curiosity and experimentation. Young adults are naturally curious and affected by influences, social rules and peer pressure, as shown in the following excerpts.  The statements above express perceived "bad influences" among friends. According to the students, the right attitude is to separate from that kind of person, as can be seen in the following statements. In regard to illegal drugs, criticism was unanimous. "Preventing drug abuse in adolescence" This category presented the needs identified and suggestions of the respondents to avoid or minimize problems arising from the use and abuse of drugs among adolescents who live in the region. The respondents mainly believe that they need safety and leisure where they live. Many said they would like to play sports and/or participate in cultural activities, but there is a lack of infrastructure such as sports fields and community centers in their neighborhoods. The students also expressed the importance of education on drugs in schools, and mentioned teachers' lack of training on the subject. Some participants cited legalization of work for minors as a preventive measure to avoid idleness and early involvement with drugs. The study participants cited their parents' positions on the problem of drugs. Some parents orient their children and others do not give due importance; instead, they trivialize the subject, as evidenced in the following statements. [

DISCUSSION
The results showed the importance of knowing how adolescents understand drugs, and the magnitude of drug use in the contexts in which they live.
Knowledge of drugs that is focused on the substance, without greater understanding of their complexity and social and economic implications, can promote a distortion of reality. It may be common to think that the problem can be resolved immediately through prohibitive and repressive discourse, relegating the process of reflection and prevention to the background (13) .
Participants reported that the meaning of drugs is related to disease, crime and immorality. These meanings may be possibly associated with historical and socially-constructed reproductions. Being used to listening to people and the media about different types of drugs, their effects and pleasures, the participants certainly made inferences based on their prior knowledge, without any major reflections. However, it is possible that these concepts were expressed in the social and behavioral spheres based on the daily reality of crime scenes widely-reported in the media, with headlines of police repression and arrests, perhaps causing fear of losing freedom, which is very important and necessary in the lives of adolescents.
Reports on drug use in the daily life of the neighborhood, on the streets and within homes, and the ease of drug trafficking in the region is a cause for great concern, since this results in various vulnerabilities for adolescents (14) . Easy access can give the impression that drug use is natural and encourage early use (15) , which can consequently cause serious family and social disorganization, with serious future repercussions (16) , especially on sexuality (17) .
This study observed that adolescents are directly exposed to drugs in the environment in which they live, whether social or familiar. Common and daily scenes of drug users in any space cannot be trivialized and disregarded without social importance. This reality causes greater reflection, and spurs deeper discussion, in various contexts and scenarios of adolescent life. Studies (18)(19) show that it is necessary to invite the parties involved for discussion of topics of interest to them, based on their experiences and socialization, using participatory and reflexive methodologies with flashy and impactful audio visual resources, with statistical information on number of cases, pictures, real cases, among others, because this issue appears as a serious social and economic problem, and affects different social classes.
As regards influences and experimentation with drugs, the participants especially cited alcohol and cigarettes. For most, the experiments were unpleasant. Cigarette smoking was associated with disease, having an unpleasant smell and being unpleasant for those who do not use.
The fact that in Brazil it is illegal to sell cigarettes to minors does not guarantee protection of this age group to exposure. The lack of supervision and awareness of storeowners has worsened the situation. Near the schools where this research was undertaken, numerous points of sale of cigarettes and alcoholic beverages were identified, and these are sold freely to people of any age group. Many of these stores did not have the proper licensing. In order to reduce the use of alcohol among young people, it is necessary to proceed in the regulatory debate over application of stricter laws regarding the prohibition of advertisements, especially beer, as these ads, with attractive messages running freely in the media, may encourage consumption of alcoholic beverages, and the public should be protected instead of exposed (20) .
Alcohol is culturally associated with fun, joy, pleasure, celebration and social integration (19)(20)(21) . For the participants of this study, the influences and curiosity for experimentation with drugs are related to internal and external factors common in adolescence, such as curiosity, influence of friends, family and the media, similar to results found in other studies (15)(16)(17)(18)(19)(20)(21)(22) .
Adolescence is a critical and fragile phase in which contestation and curiosity is present. Teenagers are curious, subject to influences, social rules and peer pressure (22) .
Regarding prevention of drug abuse in adolescence, the participants reported that idleness is the result of the limited availability of sports and leisure and socio-cultural activities in the neighborhood. They also cited the importance of early insertion into the labor market, to prevent idleness among teens. As in other studies, the need for educational work in school, teacher training, parental supervision and increased public security were cited as measures to prevent drug abuse (23)(24) .
It is therefore necessary that educational measures such as implementation and fulfillment of government actions such as the School Health Program (PSE) of the Ministry of Health be implemented as strategies to meet and work on prevention and reduction of use of alcohol, tobacco and other drugs in the school context. The program cited above includes actions to promote health and teacher training (25)(26) .
Parents' attitudes towards drugs and their effects on the family are of utmost importance. In this study, it was observed that while some parents exercise their roles as caretakers and protectors, others behave to the contrary, trivializing the subject, using drugs, and even allowing their children to purchase cigarettes and alcohol.
Parental supervision is important in the everyday life of adolescents. Common practices such as family gatherings for discussion of events and family leisure brings people together and strengthen bonds of friendship, respect and safety in the home environment (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) . It is important that parents and/or guardians monitor their children's routines, care about their habits, monitor their day-to-day life, and do not allow free time to result in idleness. Negligence by parents may stimulate greater drug use in their children while support, monitoring, and direct involvement can lower rates of use. Therefore, it is necessary that projects for drug abuse prevention be extended to parents, and guaranteed in academic planning.
Thus, better understanding of the social contexts related to drug use during adolescence is a concern for the areas of education and health, especially nursing, as there is a very wide field of action in the context of primary health care through the Family Health Strategy of the Brazilian public health network, in which the professional nurse has the social duty to subsidize and support professionals in the educational institutions in their regions (28) .
Research in the framework of other public institutions from different geographical regions of the same municipality, as well as of private education institutions, should be the object of future studies in the area. From this research, new work was expanded, based on the partnership established between the university and areas of health and education, in order to promote continuing education for public school teachers, through research and extension projects.

CONCLUSION
The use of the method of focus groups proved to be relevant, as it encouraged participation of adolescents in discussions of topics of importance and interest to them.
The adolescents' statements demonstrated limited knowledge on topics involving drugs, a result of the negative view reproduced by society and the media, therefore requiring preventive educational measures and implementation of educational work in the context in which they live, whether school, social and/or family life, in order to minimize the number of vulnerabilities to which they are exposed.
However, before proposing actions for drug abuse prevention, it is necessary to understand and know the object of study, the adolescents' views on the subject, seeking information to consider the sociocultural dimension of these subjects by means of careful listening.
Considering that this is a populated region with high levels of social violence, one limitation of this study was its scope, since the sample had only 16 participants, though it favored good approximation and interaction between the researcher and participants.
This study contributed to understanding the adolescent participants' understanding and opinions on drugs in their own context, which may support future planning of actions for health education.