high-risk behaviour of primary school learners
Maretha Visser & Anne-Gloria Moleko
Department of Psychology, University of Pretoria

Introduction
High-risk behaviour of children and adolescents such as alcohol and substance abuse, unplanned pregnancies and unprotected sexual activities, is a major concern in South Africa today. Substance abuse is recognised as one of the greatest health and social problems in South Africa.¹ Drinking and drug-taking trends in a community are frequently used as a general indicator of the quality of life in a community.² Worldwide trends indicate that when a country experiences general and drastic socio-economic or political changes as is the case in South Africa, these changes frequently impact the sphere of high-risk behaviour. It is estimated that 5,8% of the South African population over the age of 15 years are alcohol dependent¹ and that there is a progressive increase in the general level of drug, and especially alcohol, intake among adults.³ In three major studies undertaken on youth in South Africa^4-6 it was found that 34% to 55% of young persons reported current drinking of alcohol. A fair degree of risk-proneness with regard to the development of alcohol/drug-related problems among young people was found. AIDS is also a major health threat facing South African youth. In the few studies done on secondary school learners^{4, 7-9} it was found that many learners were sexually active but did not protect themselves and were therefore at risk of becoming HIV infected. Although they have basic knowledge about AIDS, they do not see AIDS as a personal threat and do not understand how the virus is transmitted.

Many of the studies on high-risk behaviour have been undertaken on secondary school learners. Although Rocha-Silva, et al.⁶ included youth from as young as 10 years in their study, there is no specific information about the younger group of learners. In this study a situation analysis was made of the high-risk behaviour of primary school learners with the aim of understanding their behaviour to enable researchers to develop appropriate intervention and prevention programmes for this age group.

Bronfenbrenner’s¹⁰ developmental theory, one of the theories which focuses on ecological systems and the interaction between the individual and his/her context, was used as the theoretical framework. High-risk behaviour can therefore be related to individual psychological factors such as self-esteem, locus of control, need for acceptance, anxiety levels and eagerness to behave like adults.^11,12 It can also be related to social and community factors such as access and exposure to the use of substances, social norms that tolerate the behaviour, lack of social support for the individual as well as inclusion in the social network. The focus of the research was at the micro-level system (school setting) with the purpose of influencing the other levels of the ecological system (family, school and policy-making systems).

Methods
Participants 
The participants were 460 Grade 6 and 7 learners in four primary schools in a historically disadvantaged urban area in the Pretoria Metropolitan area. Two of the schools were previously randomly chosen from all the schools in the area and were approached to ascertain if they were interested in participating in development programmes for their learners. These schools have been involved in development programmes of the University of Pretoria for 2 years. The other two schools heard about the programmes running in some schools and asked the researchers to become involved in their schools as well. All four schools draw a large portion of their learners from an informal settlement. The project was explained to all the grade 6 and 7 learners in these schools and they were asked to participate voluntarily. All the learners agreed and completed the questionnaire.

Questionnaire
A questionnaire was used to evaluate the knowledge, attitudes and behaviour with regard to substance abuse and sexual behaviour of the learners. The questionnaire consisted of 59 questions. Besides biographical information, questions were asked about the use of different substances such as alcohol, marijuana (dagga), solvents and over-the-counter medications, drugs like cocaine and LSD, as well as sexual behaviour, the use of contraceptives and condoms. Questions were asked with regard to the number of learners involved in high-risk behaviour, perceived reasons for high-risk behaviour, perceived approval of high-risk behaviour, perceived support and connectedness in the community, and perceived personal well being.

The questionnaires were completed in a classroom situation with the researcher and an interpreter present. The questionnaire was presented in English and Northern Sotho or Tsonga – the main languages spoken by the learners. Although the questions were formulated in simple language, the interpreter was available to learners who did not understand some of the questions. The questionnaire was completed anonymously to ensure confidentiality and a true reflection of attitudes and behaviour. A descriptive analysis was done on the reponses of the learners.

Results
Biographical information
The group of 460 learners consisted of 52% grade 6 and 48% grade 7 learners. There were 209 (45%) boys and 232 (50%) girls, while 19 respondents did not indicate their gender. The ages of the group varied from 9 to 22 years, with the majority of learners between the ages 12 and 14 years. The responses of the learners on each of the high-risk behaviours will be discussed separately.

Alcohol use
To understand the alcohol behaviour of the learners, questions were asked about their behaviour and acceptance of the behaviour (Table 1). 

Table 1: Alcohol use

From these results it can be seen that alcohol is a known substance to many of the learners and that 27% had contact with alcohol, and 14% indicated that they drank alcohol the past 30 days to get drunk. Although some of them use alcohol, the majority (87%) believe that it is not acceptable behaviour for a young person to use alcohol. One aspect that could have an influence on this behaviour is the perceived group norm which was obtained by asking how many of their friends drink alcohol. Only 8% indicated that most of their friends and 14% that some of their friends use alcohol. This indicates that the perceived group norm does not include using alcohol. The most important perceived reasons for using alcohol were to forget their problems (23%) and because they like it or for fun (21%).

Marijuana (Dagga) behaviour
The same questions were asked with regard to dagga (Table 2). 

Table 2: Dagga behaviour

From Table 2 it can be seen that dagga is not a major drug of use by primary school learners, although some of them (7%) have some experience of using dagga, and 4% had smoked dagga in the previous 30 days. Although many of the learners did not know what the long-term effect of dagga use will be (28%), the majority (91%) did not regard it as acceptable behaviour for a person their age. Perceived reasons for using dagga, are to feel good and strong (17%) and to forget their problems (14%).

Use of other substances
It was found that the use of solvents was not frequent in this group: 3% said they used them in the past 30 days, and 3% indicated that most of their peers sniff substances. Over-the-counter medicines may become a problem for the learners because 13% indicated that they use them, and 9% indicated that they used them the past 30 days to get high. However, the question could have been interpreted incorrectly that they used them as medicine and not as a drug to get intoxicated, despite the fact that it was specified in the question that they use it "to get high". Although a low percentage (2%) indicated that they have used drugs like cocaine or LSD, this corresponds with the findings of Rocha-Silva, et al. ⁶ and may be a reason for concern in this age group.

Sexual behaviour
Sexual behaviour is one of the most important high-risk behaviours as it is related to teenage pregnancy and the transmission of HIV - growing and serious problems in the community. Responses of learners with regard to sexual behaviour and knowledge about HIV/AIDS are given in Table 3.  

Table 3: Sexual behaviour of learners

From these responses it can be seen that 24% of the learners are sexually active and that many of them regard their friends as sexually active (46% see some or most of their friends as sexually active). This sets a social climate that may influence behaviour. In spite of the social climate, 77% said that it is not appropriate for learners of their age to be sexually active. An alarming factor is that many of the learners do not have accurate knowledge about the transmission of HIV and many of them might be at risk of contracting the HI virus. Forty per cent of the learners did not think that learners their age could get the virus, while 28% were unsure. Only 51% knew that a person does not know when he/she has contracted the virus and 45% knew that the virus can be passed on even when the person looks and feels healthy. Although the responses were on a yes/no basis and did not make provision for ‘sometimes’ or ‘in between’, it can be seen that 25% said they do protect themselves from HIV and 16% said that they use birth control to prevent pregnancy. Of the sexually active learners, only 40% indicated that they protect themselves from HIV by using condoms, 40% regard learners their age as at risk of getting HIV, and 35% use birth control to prevent pregnancy. These students may need some guidance about the importance of protection when they decide to be sexually active.

Attitudes towards substance use and AIDS
The attitude of the learners towards the use of substances and AIDS were assessed by means of a few questions. The majority of the students have a negative attitude towards the use of substances. Almost half of the students want to jail people who smoke dagga (49%), think that no one should use alcohol (59%) and believe that drugs are dangerous for a person’s health (56%). On the other hand, 34% think that people who use alcohol have fun, and only 31% responded that learners their age should not experiment with drugs. Their attitude towards people with AIDS is very negative. Almost half (46%) do not want to allow learners with AIDS in the school with other learners.

Self acceptance
According to Perkel, et al.¹² self-esteem is of the most important personal factors that play a role in the development of high-risk behaviour. Of the learners, 47% regard themselves as happy and 42% experience that people like them the way they are – indicating positive self-experience.

Social support
Social support and the attitude of significant other people in the child’s life may have an important influence on behaviour. A few questions were asked about their social support networks (Table 4). 

Table 4: Social support

From these results it can be seen that 53% of the learners know that their parents or caretakers disapprove of the use of drugs, while the others (22%) were not sure or knew that their caretakers would not care (22%). For 25% of the learners, alcohol and drug abuse was part of their lives as their caretakers or parents or a family member abused it. Of these learners, 37% felt that they have an adult and 30% a friend to talk to when they have a personal problem, while many of the learners indicated that they do not have an adult (27%) or a friend to talk to (23%). More than half of the learners (54%) indicated that they participate in some organised activities after school, which also presents a support network. From these results it can be estimated that about 25% of the learners do not experience enough support and may be at risk of high-risk behaviour.

Discussion
If the results of this study are compared with those of other studies (for example those described in references 4-6), it can be seen that alcohol behaviour of the primary school learners is not as high as that of secondary school learners. Nevertheless it is alarming to know that 14% of the learners, mostly under 15 years, are drinking alcohol to get drunk, to forget their problems or to feel good about themselves and to have fun. With regard to other drugs, findings were similar to those reported in studies of older children: 7% indicated that they have used dagga sometime in their lives, while 4% are currently using it. Rocha-Silva, et al.⁶ found that 3,8% of their sample used dagga. Of the respondents, 3% indicated that they used solvents to get high, while Rocha-Silva, et al.⁶ found that 7,4% did so. Over-the-counter-medication could become a problem in this community as 9% indicated that they used it the past 30 days to get high.

Substance abuse is not yet reaching critical levels in this primary school group and this makes primary and secondary prevention possible before the problem gets out of hand. It also seems that the perceived group norm does not include using alcohol. For the primary school learners this can still have a positive influence on their behaviour and can facilitate primary prevention activities. It is also evident from this study that many of the learners are confronted with alcohol and drug abuse in their own homes and that many of them do not experience positive support from their families or peers. A large proportion of these learners do not see themselves as happy and do not accept themselves. This is often a catalyst for high-risk behaviour in young persons.

The other high-risk behaviour that should be addressed urgently is unprotected sexual behaviour. Of the primary school learners, 24% indicated that they were sexually active. Only 40% of the sexually active learners protect themselves from HIV and 35% use some form of birth control. It also seems as if sexual activity is becoming part of the group norm as 46% see their friends as being sexually active. These issues need to be addressed by schools to prevent high-risk behaviour patterns that can become more serious as these learners develop.

The most common prevention approach utilised in schools relies on teaching students the factual information about high-risk behaviour and the dangers thereof. ¹³ These data indicate that these learners know that alcohol and drugs and sexual behaviour at their age is not acceptable behaviour and that it has implications for their health. Preventive programmes should therefore rather focus personal development (self-esteem development, life skills) and on ecological factors in the lives of the learners such as the provision of a social network and social support.

References 

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