The National Rehabilitation Centre, Abu Dhabi, United Arab Emirates
Received Date: January 22, 2015; Accepted Date: March 13, 2015; Published Date: March 17, 2015
Citation: Alhyas L, Elarabi H, El-Kashef A, Wanigaratne S, Almarzouqi A, et al. (2015) Parents’ Perceptions and Beliefs on Adolescence and Substance Use: A Preliminary Qualitative Study in Abu Dhabi, United Arab Emirates [UAE]. J Child Adolesc Behav 3:195. doi:10.4172/2375-4494.1000195
Copyright: © 2015 Alhyas L et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Introduction: Parents were considered as one of the main elements in the framework of theories about deviance and problem behaviors such as substance use. Despite the well-established evidence on the prominent role of the parental factors in protecting adolescents from risky behaviors such as substance use, and given the large change in the lifestyles witnessed among Emirate families; little attention was given to understanding and examining parent’s beliefs and perceptions of factors associated with substance use among adolescents. The aims of the study are to: Explore parental knowledge of substance use among adolescents in their communities, commonly used substances and patterns of use. Explore parental perception of risk and protective factors related to substance use. Explore parental attitudes towards adolescence and their perceptions of the challenges observed during adolescence. Methods: A qualitative approach utilizing six focus groups 38 parents [17 fathers and 21 mothers]. Results: Many parents were worried and complained about the initiation of new behaviours among adolescents; however they were not aware about the developmental changes adolescents undergo and its association with the initiation of new behaviours. Parents believed that individual, familial, and psychosocial related factors can moderate or increase the risk of substance use among adolescents. Apparently, the role of effective communication in enhancing the parent-adolescent relationship and moderating the risk associated with substance use was emphasized by all participants. Parents listed many factors limiting the communication with their offspring including: the vast uncontrolled use of social media, limited time allocated for children and lack of parental skills Conclusion: The present study demonstrates that, parents in Abu Dhabi can moderate the risk of substance use among adolescents if they equip themselves with the needed knowledge and skills. The important protective role of parent-adolescent communication against the initiation and involvement in risky behaviors was emphasized by our findings. To optimize parent-adolescents communication, Emirate parents in Abu Dhabi residing in the city; especially fathers should spend more time and communicate more frequently with their offspring The present study also suggest designing prevention program that considers attitudes towards substance use problem among adolescents using community mobilization in urban areas. Given the great influence of modern media on the beliefs, behaviors and attitudes of adolescents, future studies should examine this association.
Parents; Adulthood; Psychosocial; Relationship
Adolescence and young adulthood is a period of biological, intellectual and psychosocial development . Research has shown that most individuals have been initiated into substance use and abuse during this period . In Canada for example, studies indicated that the average age of first tobacco use is about 12, first alcohol use is about 13, and first use of cannabis and other drugs is about 14 .
Many studies examined parent’s role in the development of substance use, and found that parental factors have a noticeable role either in the initiation or protection against substance use among adolescents [3-7]. For example, findings from these studies confirmed an inverse association between healthy parent-adolescent relationship and adolescent substance use [3-7]. Parents were also considered as one of the main elements in the framework of theories about deviance and problem behaviors such as substance use. For instance, the social control theory consider the strong bonds between parents and their children as a protective factor for adolescent deviance . The Transitional Teens Theory (TTT), however, defines four key elements which significantly affect behaviors including:  the developmental dynamics and status of the adolescent;  parental influence;  social, environmental and community influences; and  peer influences .
In the UAE, families tend to be very cohesive, extended families used to live with or next to each other . However, due to many factors such us spread of urban lifestyle, augmentation in the life stressors (e.g., work, raising children), and the spread use of modern modes of communication (e.g., social media networks); significant changes in the lifestyle of the regular Emirate family appear. These changes most importantly influenced the family relationship, for example the vast use of social media led to weakened family ties and social isolation between family members. Al-Sayegh declared that nowadays although the Emirate family live under one roof they had different lifestyles . Many Emirate parents complain that “i-pads” have stolen their children from them, as the children don not have time either to study or to communicate with their parents or other family members .
Despite the well-established evidence on the prominent role of the parental factors in protecting adolescents from risky behaviors such as substance use, and given he large change in the lifestyles witnessed among Emirate families; little attention was given to understanding and examining parent’s beliefs and perceptions of factors associated with substance use among adolescents. Therefore, the purposes of the present study are as follows:
Explore parent’s awareness of: existence of substance use among adolescents in their communities, types of commonly used substances and their patterns of use
Explore parents’ perception and belief on risk and protective factors related to substance use and challenges observed during adolescence
Develop recommendations for future research and response strategies
A qualitative approach was used to meet the aims of this study. Focus groups were chosen to explore parental beliefs and perceptions on substance use among adolescents and related risk and protective factors. Single gender focus groups were arranged in response to UAE’s cultural and social norms.
Focus group guide consisting of a set of open-ended questions that were constructed by the study team and employed to collect information on: parent’s beliefs and perceptions on adolescence and associated behaviours; parent’s awareness about substances and their patterns of use among adolescents; parent’s views on factors related to substance use among adolescents.
Written consents were obtained from all participants, and anonymity and confidentiality were assured. All focus groups were audio-recoded and transcribed verbatim.
Recruitment and sample
Ethical approval was obtained from the Research Ethics Committee (REC) at the National Rehabilitation Centre [NRC]. Then participants were recruited across different regions representing socio-demographics variability in the Emirate of Abu Dhabi. Abu Dhabi is the capital of the UAE [population 8 million] with the largest population roughly 2.3 million . It consists of three main regions, namely Abu Dhabi city (the federation capital), Eastern region and Western region . To ensure geographical presentation samples across the Emirate of Abu-Dhabi including Abu-Dhabi the capital [representing urban area], Eastern Al-Ain [representing major suburban] and the Western Madinat Zayed [representing rural area] Regions were included. Snowballing technique was employed to create a database of respondents covering all socio-economic and demographic groups. This was initiated by visits to households coupled with a referral process conducted by local field recruiters.
After data collection, the audio-taped interviews were transcribed verbatim by the researcher [interviewer] and analysed by the research team [the interviewer and 2 researchers] using thematic analysis. This research process tends to investigate experiences, meanings and reality of the participants .
|Respondents||Gender||Age||Number of participants||Location|
Table 1: Distribution of the study samples.
Six focus groups were carried out and a total of 38 parents [17 fathers and 21 mothers] participated. Findings grouped under three main themes including:  parent’s perception about adolescence and related behaviours;  parent’s awareness of substances use and patterns of use among adolescents; and  perceived protective and risk factors for substance use among adolescents.
Perceptions about adolescence and related behaviours
When participants were asked to express their perceptions and beliefs about adolescence, mothers and fathers talked about the large change in their children’s behaviors during adolescence. Majority of parents agreed that it’s a transitional period to adulthood, while others perceived it as a dangerous period associated with the initiation of many risky behaviors. More frequently mothers mentioned the shift in their children’s preference to spend time with their friends and media instead of spending it with them.
“My son has his own friends who like to spend all his time with either by visiting them at their homes, going out or chatting with them on the phone. I think he is closer to his friends than me” Mother
Majority of parents associated adolescence with specific behaviours including smoking cigarettes, flirting, car racing, using drugs and alcohol, delinquency, picking up contemporary fashion and style. Furthermore, mothers expressed their worries regarding sexual harassments among adolescents.
“When you mentioned teenagers many things came into my mind such as: coming back to the home very late, smoking shisha, midwakh [local pipe] and cigarettes, being involved in risky behaviours like drinking alcohol or using tramadol” Father
However, only few participants addressed the different physical, psychological and social changes their children undergo from childhood to adolescence:
“Adolescence is the period of change. Many physical changes appear as a result of puberty” Mother
“I think children become more mature. They have their own opinions and do not like their parents to interfere with their choices and views” Father
Awareness of substances use and patterns of use among adolescents
Awareness on the existence of substance use, source of information about substances, types and the most commonly used substances, and health hazards associated with substance use among adolescents were explored.
Many fathers and mothers were aware about the existence of substance use among some adolescents. Mothers raised their concern about the spread use of tobacco products and drugs in the school environment:
“My neighbour told me that drugs are widely used in schools, and many children started smoking cigarettes when they are very young around 8 years in the school’s toilets” Mother
However, few fathers did not accept that substance use might exist among some adolescents in their communities: “I don’t think that we have drug use problem in our city. If exists, I’m sure my children do not mix with drug users” Father
Fathers had greatest awareness about the different drug names commonly used by adolescents such as “Tramadol, Xanax and Kemadrin” compared to mothers; however they were not familiar with any street names common in the UAE. Interestingly, a large number of mothers declared that adolescents broadly use large quantities of analgesics, specifically “Paracteamol” mixed with caffeinated/ carbonated drinks, and they associated this practice with addiction: “My daughter told me that many girls mix 5-8 tablets of Panadol with RedBull and drink it. I think this mixture become a drug that lead to addiction” Mother
Majority of participants mentioned the media including social media and TV, and stories they hear from their families and friends as the main source of information about the commonly used substance among adolescents. Some fathers also stated that they became aware about certain type of drugs and their route of administration due to their work nature: “I work in the prison, and I saw many teenagers who were incarcerated because of being addicted to tramadol and other hallucinogenic tablets” Father
Inadequate knowledge regarding the health hazards associated with the use of substances was prevalent among majority of participants: “People who are addicted to tramadol become mad” Father
However, remarkably all of them associated smoking with lung and gum cancer: “Smoking cigarettes can cause lung and gum cancer” Father
Perceived protective and risk factors associated with substance use among adolescents
Parents agreed on several factors that either increase or moderate the risk of substance use among adolescents. These factors fall under three main domains including individual, familial; and psychosocial related factors.
Individual related factors
Fathers only agreed that many adolescents use substances due to personal factors. They believe that adolescents use tobacco products to assert manhood, and improve confidence: “Many boys use drugs to reduce their fear. For example, if they want to get involved in car racing, some of them take drugs to feel brave and do not care about the related risks” Father
“When boys smoke they think they look mature and attractive; especially to girls” Father
Familial related factors
Mothers and fathers believe that providing regular monitoring and supervision to adolescents are protective factors against many risky behaviours including substance use. Mothers specifically think that reinforcing religious beliefs and practices, adopting a daily routine, and getting involved in adolescent’s activities are other important protective factors against problem behaviours.
“Organizing the time at home important. A schedule for homework and other things should be set in the same time daily” Mother
“Encouraging children to pray is important. Also, parents should share religious stories which deduce their wisdom with their children to reinforce morals and values” Mother
On the other hand, all participants agreed that poor parent-adolescents relationship, frequent parental conflicts, father or other older sibling problem behaviours [e.g., smoking cigarettes and drinking alcohol], and excess or little money given to the adolescents can lead to the initiation of many risky behaviours.
“Having too much pocket money can increase the risk of buying drugs. On the other hand, having little money encourages the boy or girl to try obtaining money from different sources. Some boys or girls sell pills in the schools to collect money” Mother
The role of effective communication in enhancing the parent-adolescent relationship and moderating the risk associated with substance use was emphasized by all participants. Participants listed many factors limiting the communication with their offspring including: the vast uncontrolled use of social media, limited time allocated for children and lack of parental skills. Majority of mothers also shared their worries on the information their children get access to, and the relationship they build though social media.
“The technology make the dangerous and unknown world in the boy or girl fingertips. We can’t control the Internet or the smart phones” Father
“Adolescents are communicating using the Internet and smart phones, they are building relationships and making new friends. The world comes to them while they are sitting in their rooms” Mother
Fathers residing in the city of Abu Dhabi shared their worries about the limited time they allocate to their children compared to fathers residing in the Western and Eastern regions:
“I don’t have enough time to spend with my family. After work, I go to the gym then I meet my friends, and when I reach home it’s sleeping time” father
In the contrary, fathers residing in the Western and Eastern regions mentioned that they split their time between their work and family responsibilities: “I try to allocate time for my children on daily basis to talk to them and be aware about things happened to them and guide them when it’s needed” Father
Furthermore, mothers expressed their worries about difficulties they face while communicating with adolescents, and they suggested launching parental educational sessions in the schools and communities that focus on the appropriate parenting styles, and parenting skills to enhance their communication with their children.
“I need to have good skills to be able to encourage my daughter to express her worries to me.” Mother
“We do not talk usually. I ask her about the school and her exams, she answers briefly and stay silent. I don’t know how to make the conversation interesting to her” Mother
Psychosocial related factors
Peer pressure and adolescents culture
Majority of participants perceive school as the chief influencer on the student’s behaviours because of many reasons. One of the reasons is the peer associations and culture, parents raised their concern about the key role peers can play either in moderating or escalating the risk of substance use.
“Involvement with peers who smoke cigarettes in the school toilets, would encourage their friends to try or smoke cigarettes” Father
Mothers also think that social favourability/ group attachment is the main motive for substance use among adolescents: “Always adolescents like to copy their friend’s behaviours. Being with good friend can protect children from getting involved in risky behaviours” Mother
To enhance safety in schools and protect against risky behaviours the following were suggested by parents: providing regular comprehensive reports to the parents on the student’s social behaviours and attendance at school, using Closed Circuit Monitoring System CCTV, strengthening the Islamic beliefs among students, carrying out usual inspections and carrying protective educational programs against risky behaviours starting from early ages. However, few fathers shared their worries regarding raising awareness on substance use in the community and schools: “I don’t want my children to be aware of the existence of different substances, they might be curios to try or even use pills” Father
“More attention should be given to the Islamic subject in the school; especially the private ones. In my daughter’s school they focus on building religious beliefs during the class and assembly time which I consider a good intervention against the initiation of risky behaviours among adolescents” Mother
Parents believe that involving adolescents in community related activities can protect them from many risky behaviours. Hence, mothers and fathers residing in the Western region of Abu Dhabi suggested increasing the number of community based activities: “Lack of activities make teenagers feel bored. Some teenagers get involved in gangs to fill their spare time; especially in the summer holiday” Father
“My children feel bored. I take them every day to the farm, but they want to do something new” Father
Some mothers also highlighted the need for carrying out innovative courses, a wide range of workshops and activities that cover all manner of creative pursuits aimed at teenagers.
“We need some new and attractive courses that increase our children creativity and thinking” Mother
Parents suggested carrying these programs in schools and communities using modern media to enhance adolescent’s attendance and participation such activities and programs: “Attractive media can be used to invite boys and girls to attend awareness campaigns on substance use like sending messages through Blackberry Messenger BBM” Father.
The present study is, to our knowledge the first to explore parental perception of risk and protective factors related to substance use among adolescents in the Emirate of Abu Dhabi. The results of this study may have important implications for prevention and intervention efforts in substance use among adolescents.
We found that although majority of participants from both gender linked adolescence with the initiation of new behaviors [e.g., preference to spend time alone or with friends]; they were not aware about the association between the developmental stages [e.g., physical, psychological and social] of adolescence and the initiation of these new behaviors. Researchers explained that adolescents search for their own identity, thus they pull away from their parents and friends become closer and more important [13,14]. In view of above, educating parents about the changes associated with adolescence can help parents adapting with their children’s changing needs from childhood to adolescence.
All the participants in this study showed awareness about the commonly sued substances among adolescents in their sittings; however fathers had greater awareness of the names and routes of administration than mothers. This might be due to the job nature of some fathers that exposed them to these substance. Mothers in the other hand, addressed a new practice that they believe is common among females as female adolescents informed their mothers -mixing analgesics with caffeinated/carbonated drinks- and they considered it as a type of addiction, but fathers were not aware about this practice. This result indicates that female adolescents compared to males, interact and communicate more frequently with their mothers, similarly to the findings from other studies [15,16]. In other words, mothers are involved more than fathers in parenting adolescents; therefore adolescent relationship with their mother is stronger than fathers [15,16].
Inadequate knowledge of mothers and fathers on the health hazards resulting from substance use is a worrying finding. Many studies [17-19] addressed the protective role of educating adolescents about the health hazards related to substance use, and considered parents as the first line and the prime source of teaching children essential coping and life skills [18,19]. Therefore, Emirate parents should take or share the responsibility of educating their offspring about the risky behaviors and needed skills to face life stressors; otherwise this gap in knowledge can be filled inappropriately by many sources such as the modern media, and deviant peers.
As discussed by many studies [13,14], individual related factors can operate as either risk or protective factors influencing adolescent behaviors. In this study we found that positive expectancies for using tobacco products among adolescents was perceived by fathers only as a risk factor. For example, they mentioned that male adolescents feel more confident and mature when using tobacco products. Similarly in another study carried out in the Emirate of Abu Dhabi, adolescents themselves declared that some peers use substances namely tobacco products to attract others and assert manhood . As emphasized by the containment theory, positive self-image can buffer adolescents against peer associations which might lead to problem behaviors . Practically, these finding demonstrate the possible advantage of tailoring prevention efforts addressing the protective role of self-concept and health-positive cognition and behavior against risky behaviors.
Our finding on the protective role of healthy parent-adolescent relationship is consistent with many theories about deviance and problem behavior and by many studies focusing on adolescents [3-5,15]. Based on the perceptions of parents, we found that in Abu Dhabi, similarly to many other settings in the world, parent-child communication, which is reflective of the parent-child relationship is affected negatively by the uncontrolled use of social media, limited time spent with children and lack of parental skills. Findings from some studies [21,22] demonstrated a reduction risks for tobacco onset and alcohol use in the past month due to the sufficient amount of time parents spend with their children and frequency of parent-child communication.
As discussed earlier, the evolving of new mode of communication among Emirate family changed the lifestyle of the family, particularly the youth . Due to the popularity of the modern media use among youth in the UAE, it was called “an alternative home for the young” . Parents, community and the school should participate in regulating the media use among adolescents in the UAE. Limiting the total time spend interacting with media to roughly 1 to 2 hours daily and keeping all the internet devices outside the child’s bedroom [23,24] were suggested by researchers to regulate media use among adolescents in the house. In the school setting, school physicians, nurses and social workers should take part in educating the school administrator and student’s families on the risk associated with the unsupervised and unlimited access to the media; especially by adolescents [23,24].
The difference in the level of father’s involvement with their families between those residing in the city and those residing in rural areas is evident in this study. This finding is consistent with previous research [e.g.,25] that demonstrated the less effective fathers’ role in the context of family relationship compared to mothers. Although in many studies most adolescents reported high mother-adolescent relationship, lack of important social skills and coping strategies for real world interactions can result from the alienation in the father-child relationship . Emirate fathers should be encouraged to realize the influence of father-adolescents relationship on adolescents and its association with the initiation on problem behaviors.
Lack of parenting skills also was seen as an obstacle for effective parent-child relationship in this study. Thus, parenting skills should be given attention in the educational programs carried out in schools and communities in Abu Dhabi.
The emirate of Abu Dhabi has a healthy community that focuses on the positive building blocks of human development; however some participants from the Western Regions of the Emirate of Abu Dhabi shared the need for carrying more innovative and attractive activities for adolescents. Similarly, findings from two studies carried among youth in the UAE [17,20] insisted on the need of establishing attractive entertainment centres for adolescents.
Remarkably, some of the findings on the parents beliefs on the protective factors [e.g., religiosity, using CCTV system in the school, , parental monitoring] and risk factors [e.g., poor parent-children relationship, peer-pressure] for substance use among adolescents, are similar to the adolescents beliefs cited in another study . Such an alignment in the perception of risk and protective factors between the parents and adolescents thinking should contribute to effective prevention programs.
In summary, this study has certain limitations that are acknowledged. First, all the study subjects were from Abu Dhabi only, and subjects from other emirates might have different perceptions and experiences. Generalizability of the findings, however, was not the aim of this study but rather to explore the perception of a small group of parents on substance use among adolescents and understand their needs. It would be useful, if future studies explore the perception of parents on substance use and related factors over a large representative sample of the UAE. Second, the lack of socioeconomic data of participants, might affect their perceptions and beliefs; therefore we suggest future research to include this variable while collecting data to study its association on substance use among adolescents.
In summary, the present study demonstrates that, parents in Abu Dhabi can moderate the risk of substance use among adolescents if they equip themselves with the needed knowledge and skills. This study emphasize on the important protective role of parent-adolescent communication against the initiation and involvement in risky behaviors. To optimize parent-adolescents communication, Emirate parents in Abu Dhabi residing in the city; especially fathers should spend more time and communicate more frequently with their offspring. Educating parents also about the developmental changes associated with adolescence, parenting skills and health hazards associated with substance use is essential. The present study also suggest designing prevention program that considers attitudes towards substance use problem among adolescents using community mobilization in urban areas. Given the great influence of modern media on the beliefs, behaviors and attitudes of adolescents, future studies should examine this association.
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