The Open Public Health Journal




ISSN: 1874-9445 ― Volume 13, 2020
RESEARCH ARTICLE

Prevalence of Strox Smoking Among University Students in Cairo, Egypt



Ahmed M. M. Hashim1, Ahmed M. Hassan1, Ghada Essam El-Din Amin1, Mohamed Farouk Allam1, 2, *
1 Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2 Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Cordoba,Córdoba, Spain

Abstract

Background:

In Egypt, the prevalence rate of New Psychoactive Substances (NPSs) use is severely underestimated. In the last 5 years, several non-scientific reports have demonstrated the presence of an emergent, cheap NPSs that has taken the name of “Strox” or “Egyptian Spice”. The objective of this study was to estimate the prevalence rate of Strox smoking among undergraduate students attending Ain Shams University (ASU), Cairo (Egypt).

Methods:

A cross-sectional study was conducted in five non-medical colleges of ASU, namely, Law, Commerce, Computer Science, Engineering, and Literature. Participants were recruited using a convenient sampling method and were asked about NPSs use. Data were collected using the Marijuana Smoking History Questionnaire (MSHQ) developed by Bonn-Miller and Zvolensky (2009). The questionnaire was translated and modified to reflect Egyptian slang and culture.

Results:

This study included 558 students, 422 (75.6%) males and 136 (24.4%) females. The results showed that 189 (33.9%) were current tobacco smokers, 51 (9.1%) were smokers of substances other than tobacco, 45 (8.1%) were cannabis smokers, 38 (6.8%) were Strox smokers, and 3 (0.5%) were Voodoo smokers. When students were asked about their reasons for smoking Strox, they cited the following motivations: to achieve a feeling of euphoria(28.9%), depression (23.7%), experimentation (23.7%), peer pressure (21.1%), and having excess money (2.6%). The results showed a clear association between tobacco and cannabis smoking and consumption of Strox.

Conclusion:

Although the prevalence rates of NPSs usage as observed in this study were not high, higher rates could be expected in other communities outside of the university. Community-based studies are needed to estimate the magnitude of NPSs use in Egypt and the associated risk factors.

Keywords: Smoking, Cannabis, Strox, Voodoo, Drug use, Prevalence.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 13
First Page: 425
Last Page: 429
Publisher Id: TOPHJ-13-425
DOI: 10.2174/1874944502013010425

Article History:

Received Date: 03/02/2020
Revision Received Date: 10/07/2020
Acceptance Date: 15/07/2020
Electronic publication date: 19/08/2020
Collection year: 2020

© 2020 Hashim et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University. 11566 Abbasia, Cairo, Egypt; Tel: + (2) 011 43559946; Fax: +(202) 24346888; E-mail: farouk.allam@med.asu.edu.eg





1. INTRODUCTION

Substance Abuse (SA) is considered one of the major health problems that has been faced by humanity in the last few decades [1Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2224-60.
[http://dx.doi.org/10.1016/S0140-6736(12)61766-8] [PMID: 23245609]
]. A globally applicable definition of SA is a matter of much debate; however, according to the WHO, SA is defined as the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Abuse of different substances, legalized or not, is noted as an important cause of morbidity and premature deaths [2Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 2009; 373(9682): 2223-33.
[http://dx.doi.org/10.1016/S0140-6736(09)60746-7] [PMID: 19560604]
-4Wysowski DK, Schober SE, Wise RP, Kopstein A. Mortality attributed to misuse of psychoactive drugs, 1979-88. Public Health Rep 1993; 108(5): 565-70.
[PMID: 8416115]
]. In 2016, an estimated 6.8% of the Egyptian population over the age of 15 years regularly engaged in substance abuse [5Emad Hamdi NS. Albert Sedrak, Aref Khowailed, Nasser Loza, Menan Rabie, Hisham Ramy. Sociodemographic Indicators for Substance Use and Abuse in Egypt. J Addict Prev 2016; 4(1)].

As a result of authorities’ and communities’ restriction of legalized drug use together with the criminalization of many substances previously abused freely [6Johnson K, Holder H, Ogilvie K, et al. A community prevention intervention to reduce youth from inhaling and ingesting harmful legal products. J Drug Educ 2007; 37(3): 227-47.
[http://dx.doi.org/10.2190/DE.37.3.b] [PMID: 18047181]
-8Das JK, Salam RA, Arshad A, Finkelstein Y, Bhutta ZA. Interventions for Adolescent Substance Abuse: An Overview of Systematic Reviews. J Adolesc Health 2016; 59(4S): S61-75.
[http://dx.doi.org/10.1016/j.jadohealth.2016.06.021] [PMID: 27664597]
], a new beast has reared its ugly head: New Psychoactive Substances (NPSs) [9Johnson LA, Johnson RL, Portier RB. Current “legal highs”. J Emerg Med 2013; 44(6): 1108-15.
[http://dx.doi.org/10.1016/j.jemermed.2012.09.147] [PMID: 23528960]
]. According to the UNODC (United Nations Office on Drugs and Crime), NPSs are defined as substances of abuse, either in a pure form or a preparation, that are not controlled by the 1961 Single Convention on Narcotic Drugs or the 1971 Convention on Psychotropic Substances but which may pose a public health threat. Despite global efforts to control NPSs, approximately 739 different NPSs were reported between 2009 and 2016. In 2015 alone, 500 different NPSs were in the market [10UNOoDa C. UNODC World Drug Report 2017. Crime UNOoDa, (ed). 2017.]. The explosion of NPS abuse has been attributed to the internet revolution, together with the attractive, colorful designs of the packaging, which make NPSs appealing to young people [11Corazza O, Demetrovics Z, van den Brink W, Schifano F. ‘Legal highs’ an inappropriate term for ‘Novel Psychoactive Drugs’ in drug prevention and scientific debate. Int J Drug Policy 2013; 24(1): 82-3.
[http://dx.doi.org/10.1016/j.drugpo.2012.06.005] [PMID: 22883544]
].

In Egypt, the prevalence rate of NPSs use is seriously underestimated. In the last 5 years, several non-scientific reports have demonstrated the presence of emergent, cheap NPSs called “Strox” or “Egyptian Spice”. Other NPSs, like Voodoo, were also reported but to a lesser extent. In 2017, the hotline of addiction treatment under the Ministry of Social Solidarity (MOSS) reported that 4.3% of the 10,400 cases seeking medical support were Strox-related [12Egyptian Fund to Fight and Treat Drug Addiction and Abuse. Ministry of Social Solidarity Available at: http://drugcontrol.org.eg/media/NewsList/Item_489]. In April 2018, the frequency of hotline contacts who were Strox addicts increased by more than five-fold, reaching 22% of the total 6948 who contacted the hotline [13Egyptian Fund to Fight and Treat Drug Addiction and Abuse. Ministry of Social Solidarity Available at: http://drugcontrol.org.eg/media/NewsList/Item_526]. No comprehensive studies were conducted in Egypt about to what degree it causes dependence.

The objective of the present cross-sectional study is to estimate the prevalence rate of Strox smoking among undergraduate students in 5 non-medical colleges of Ain Shams University (ASU), Cairo (Egypt).

2. METHODOLOGY

2.1. Study Setting

5 non-medical colleges of ASU were randomly selected: Law, Commerce, Computer Science, Engineering, and Literature.ASU, the third Egyptian university, was founded in July 1950, and it is located in the center of Cairo.

2.2. Study Period

March 2018.

2.3. Study Population

Undergraduate students attending the five colleges mentioned above were included in the study.

2.3.1. Inclusion Criteria

Undergraduate students, male or female, attending one of five non-medical colleges (Law, Commerce, Computer science, Engineering, and Literature) of ASU.

2.3.2. Exclusion Criteria

Graduate students, undergraduate students in colleges other than the abovementioned colleges, or graduate or undergraduate students at any university other than ASU.Students who refused to participate in the study.

2.4. Sampling Method

Participants were recruited using a convenient sampling method on which the interviewers visited each college and invited the students randomly to share in the study after clarifying the aim of the study, on the campus outdoor setting in front of the targeted college.

2.5. Sample Size

The sample size was calculated according to the results of the Egyptian Fund to Fight and Treat Drug Addiction and Abuse study, which was conducted in 2018 [13Egyptian Fund to Fight and Treat Drug Addiction and Abuse. Ministry of Social Solidarity Available at: http://drugcontrol.org.eg/media/NewsList/Item_526].

  • Total number of students in the 5 non-medical colleges of ASU: Approximately 65,000.
  • Excepted prevalence rate: 22%
  • Level of confidence (1 - Alpha Error): 95%
  • Accuracy: 5%
  • Provisional sample size: 263

Sample size was calculated using EPIDAT software version 4.1.

Because no previous study was conducted about the prevalence of strox smoking among university students in Egypt, the researchers decided to double the number of the estimated sample size (total 526). The final sample size was augmented to 558 students.

2.6. Ethical Considerations

Oral verbal informed consent was obtained from every participant, and confidentiality was ensured. Confidentiality measures that were applied in this research included the following: 1) Name, phone number or any type of personal identification were not required or even existed in the form; 2) the interviewers were instructed not to attend the process of filling of the form by the participants (in the nearby, but not closely attending); 3) All the participants were instructed to deliver their response directly into a box full of other participant responses; 4) The interviewers were trained by the corresponding author (MFA) about the common pitfalls that can breach the participant confidentiality.

This study was approved by the Ethical Committee of Ain Shams Medical School.

2.7. Study Procedures

The questionnaire was administered by 28 interviewers (medical fellow students) who had been previously trained for 1 day regarding how to complete the questionnaire for the participants. Students who agreed to participate in the study filled the form on their own with the interviewer in the nearby (but not closely attending) to resolve any query of the participant. The number of students that refused to participate in the study was 16.

2.8. Study Tools

Data were collected using the Marijuana Smoking History Questionnaire (MSHQ) developed by Bonn-Miller and Zvolensky (2009) [14Bonn-Miller MO, Zvolensky MJ. An evaluation of the nature of marijuana use and its motives among young adult active users. Am J Addict 2009; 18(5): 409-16.
[http://dx.doi.org/10.3109/10550490903077705] [PMID: 19874161]
]. This questionnaire was previously used and validated in previous studies [15Haug NA, Padula CB, Sottile JE, Vandrey R, Heinz AJ, Bonn-Miller MO. Cannabis use patterns and motives: A comparison of younger, middle-aged, and older medical cannabis dispensary patients. Addict Behav 2017; 72: 14-20.
[http://dx.doi.org/10.1016/j.addbeh.2017.03.006] [PMID: 28340421]
-17Borcherding MJ. Marijuana Use Among Community College Students: A Study of Academic and Social Involvement 2016.]. The questionnaire was translated with back-to-back translation and modified to reflect Egyptian slang and culture. A section for MSHQ was added to include the sociodemographic data of the interviewed students.

2.9. Statistical Analysis

A data entry screen was created using Microsoft Excel. Data were checked, coded, and entered into the computer. Double data checking was performed. First, the following descriptive statistics were calculated: frequency, percent, mean and standard deviation. Thereafter, comparisons were performed using Student’s t-test for continuous variables and Pearson’s Chi square test/Fisher’s exact test for categorical variables. The level of significance was set at p <0.05.

2.10. Statistical Package

Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 23.0.

3. RESULTS

This study included 558 students, 422 (75.6%) males and 136 (24.4%) females. This opportunistic sample of undergraduate students was recruited from 5 colleges: Computer science, 87 students (64 males and 23 females); Business, 94 students (69 males and 25 females); Law, 146 students (126 males and 20 females); Literature, 167 students (111 males and 56 females); and Engineering, 64 students (52 males and 12 females).

Participants were students in the following years: first year, 233 students; second year, 139 students; third year, 100 students; and fourth year, 86 students. No statistically significant difference was found between academic year and gender (p-value 0.38).

The obtained results showed that 189 students (33.9%) were current tobacco smokers, 51 (9.1%) were smokers of substances other than tobacco like marijuana, 45 (8.1%) were cannabis smokers, 3 (0.5%) were Voodoo smokers, and 38 (6.8%) were Strox smokers. Table 1 shows the gender distribution of smokers of tobacco, substances other than tobacco, cannabis, Voodoo, and Strox. This table clearly shows the higher prevalence rate of smoking different substances among males than females.

Table 1
Comparison between males and females with regard to smoking of tobacco, substances other than tobacco, cannabis, Voodo and Strox.


Upon asking the 38 students smoking Strox their reasons for engaging in that unhealthy practice, they stated the following motivations: to feel euphoria [11 (28.9%) Strox smokers], depression [9 (23.7%) Strox smokers], experimentation [9 (23.7%) Strox smokers], peer pressure [8 (21.1%) Strox smokers], and having excess money [1 (2.6%) Strox smoker].

Table 2 shows a clear association between tobacco smoking and the consumption of Strox. The same clear association was observed between cannabis smoking and consumption of Strox.

4. DISCUSSION

The main aim of the present study was to shed light on the prevalence rate of NPSs like Strox use among undergraduate students attending five non-medical colleges in Cairo, Egypt. Undergraduate university students were selected because it is expected that their educational level could be protective against NPSs use.

Before reaching conclusions based on the present results, it is necessary to consider a number of potential objections to the methodology. This study included a specific population, undergraduate university students from non-medical colleges, thus, the results could not be generalized. Furthermore, in a cross-sectional study about NPSs consumption, the possibility of an artefact, like selection bias (university students have high educational level) or systematic bias (university students consuming NPSs may not attend lectures in their colleges), could not be excluded. The stigma of using NPSs among undergraduate university students could underestimate the prevalence rates of cannabis, Voodoo, and Strox smoking.

Table 2
Association between Strox, gender, tobacco, cannabis and voodoo smoking among the participating students.


It is unlikely that stigma would have impeded the credibility of the response, however, all responses were collected anonymously, with answers placed in a box full of other responses. Similarly, other factors, like incentives to encourage false positive responses or fear of legal consequences, were eliminated, given the methods of data collection.

The use of NPSs, also called legal Spice, is an alarming global problem that has become more marked in the last few decades [18Lamy FR, Daniulaityte R, Nahhas RW, et al. Increases in synthetic cannabinoids-related harms: Results from a longitudinal web-based content analysis. Int J Drug Policy 2017; 44: 121-9.
[http://dx.doi.org/10.1016/j.drugpo.2017.05.007] [PMID: 28578250]
]. Despite the great efforts that have been made to diminish their skyrocketing use, the number of NPSs is still increasing together with the number of users [19Castaneto MS, Gorelick DA, Desrosiers NA, Hartman RL, Pirard S, Huestis MA. Synthetic cannabinoids: epidemiology, pharmacodynamics, and clinical implications. Drug Alcohol Depend 2014; 144: 12-41.
[http://dx.doi.org/10.1016/j.drugalcdep.2014.08.005] [PMID: 25220897]
].

In Egypt, very few studies, if any, have been carried out to estimate the magnitude of NPSs like Strox or Voodoo use at the community level.

The present study showed that the prevalence rate of Strox usage among undergraduate students at Ain Shams University was less than 7%, while Voodoo usage did not reach 1%. A study investigating the prevalence rate of other NPSs(Spice, K2) among US college students from two different universities reported a higher prevalence rate of 17% [20Egan KL, Suerken CK, Reboussin BA, et al. K2 and Spice use among a cohort of college students in southeast region of the USA. Am J Drug Alcohol Abuse 2015; 41(4): 317-22.
[http://dx.doi.org/10.3109/00952990.2015.1043438] [PMID: 26030768]
]. Although the prevalence rates of NPSs usage in this study were not high, higher rates could be expected in other communities beyond the university, as denoted by a recent report of the Egyptian Fund to Fight and Treat Drug Addiction and Abuse [13Egyptian Fund to Fight and Treat Drug Addiction and Abuse. Ministry of Social Solidarity Available at: http://drugcontrol.org.eg/media/NewsList/Item_526].

Indeed, these large differences in NPSs use between Egypt and the USA should be considered with caution, as fear of social stigma is considered a barrier to reporting substance use and seeking treatment [21Lee N, Boeri M. Managing Stigma: Women drug users and recovery services. Fusio 2017; 1(2): 65-94.
[PMID: 30140790]
], especially in eastern countries known for strict social control [22Ibrahim Y, Hussain SM, Alnasser S, Almohandes H, Sarhandi I. Patterns and sociodemographic characteristics of substance abuse in Al Qassim, Saudi Arabia: a retrospective study at a psychiatric rehabilitation center. Ann Saudi Med 2018; 38(5): 319-25.
[http://dx.doi.org/10.5144/0256-4947.2018.319] [PMID: 30284986]
].

The prevalence rate of substance use was significantly higher among males than females, with significant differences for tobacco, cannabis, and Strox. In general, males are known for their greater tendency to engage in drug and substance abuse [23Becker JB, Hu M. Sex differences in drug abuse. Front Neuroendocrinol 2008; 29(1): 36-47.
[http://dx.doi.org/10.1016/j.yfrne.2007.07.003] [PMID: 17904621]
, 24Schepis TS, Desai RA, Cavallo DA, et al. Gender differences in adolescent marijuana use and associated psychosocial characteristics. J Addict Med 2011; 5(1): 65-73.
[http://dx.doi.org/10.1097/ADM.0b013e3181d8dc62] [PMID: 21769049]
]. The gender-based difference may be even more pronounced in the case of NPSs use. In this study, males represented 94.7% of Strox smokers while females were 5.3%. These results are consistent with a previous study reporting a high prevalence of NPSs use among males (68%) compared to that among females [20Egan KL, Suerken CK, Reboussin BA, et al. K2 and Spice use among a cohort of college students in southeast region of the USA. Am J Drug Alcohol Abuse 2015; 41(4): 317-22.
[http://dx.doi.org/10.3109/00952990.2015.1043438] [PMID: 26030768]
]. These results are also in line with other Egyptian community-based reports of substance use, demonstrating a higher prevalence among males [25Hamdi E, Gawad T, Khoweiled A, et al. Lifetime prevalence of alcohol and substance use in Egypt: a community survey. Subst Abus 2013; 34(2): 97-104.
[http://dx.doi.org/10.1080/08897077.2012.677752] [PMID: 23577901]
].

Of note, about one-fourth (23.7%) of Strox smokers reported depression as the main cause for its consumption, this could imply a need for better mental health services in the Egyptian colleges.

Tobacco, the most prevalent hazardous substance used worldwide [26Gowing LR, Ali RL, Allsop S, et al. Global statistics on addictive behaviours: 2014 status report. Addiction 2015; 110(6): 904-19.
[http://dx.doi.org/10.1111/add.12899] [PMID: 25963869]
], is known not only for its adverse cardiopulmonary effects [27West R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychol Health 2017; 32(8): 1018-36.
[http://dx.doi.org/10.1080/08870446.2017.1325890] [PMID: 28553727]
] but also for its ability to increase the risk of other substance use disorders, such as use of gateway substances [28Lai S, Lai H, Page JB, McCoy CB. The association between cigarette smoking and drug abuse in the United States. J Addict Dis 2000; 19(4): 11-24.
[http://dx.doi.org/10.1300/J069v19n04_02] [PMID: 11110061]
-30Agrawal A, Budney AJ, Lynskey MT. The co-occurring use and misuse of cannabis and tobacco: a review. Addiction 2012; 107(7): 1221-33.
[http://dx.doi.org/10.1111/j.1360-0443.2012.03837.x] [PMID: 22300456]
]. It was found that 89.5% of Strox smokers were also tobacco smokers (p value <0.001). These results are identical to previously published data, indicating that all NPSs addicts were tobacco smokers [31Gunderson EW, Haughey HM, Ait-Daoud N, Joshi AS, Hart CL. A survey of synthetic cannabinoid consumption by current cannabis users. Subst Abus 2014; 35(2): 184-9.
[http://dx.doi.org/10.1080/08897077.2013.846288] [PMID: 24821356]
].

In addition to tobacco, cannabis is considered another major gateway substance [32Secades-Villa R, Garcia-Rodríguez O, Jin CJ, Wang S, Blanco C. Probability and predictors of the cannabis gateway effect: a national study. Int J Drug Policy 2015; 26(2): 135-42.
[http://dx.doi.org/10.1016/j.drugpo.2014.07.011] [PMID: 25168081]
]. The percentage of dual smokers of both cannabis and NPSs was 55.3%, with a highly significant association (p value<0.001). It has been previously reported that more than 86% of NPSs users smoke cannabis on 5 or more days per week [31Gunderson EW, Haughey HM, Ait-Daoud N, Joshi AS, Hart CL. A survey of synthetic cannabinoid consumption by current cannabis users. Subst Abus 2014; 35(2): 184-9.
[http://dx.doi.org/10.1080/08897077.2013.846288] [PMID: 24821356]
].

These results call for health education programs for college students and establishing college policies against drug consumption, especially NPSs.

In general, Egypt lacks studies about drug use, especially the use of cannabis and NPSs. New community-based studies are needed to estimate the magnitude of NPSs use in Egypt and the associated risk factors.

CONCLUSION

1. The prevalence of Strox use among college students was almost as high as the prevalence of cannabis use.

2. Strox use was more prevalent among males.

3. Strox users were likely to be smokers of tobacco and cannabis.

4. The most prevalent reason for smoking Strox was to feel euphoria, but that this was closely followed by depression, experimentation, and peer-pressure.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

This study was approved by the Ethical Committee of Ain Shams Medical School, Egypt.

HUMAN AND ANIMAL RIGHTS

Not applicable.

CONSENT FOR PUBLICATION

Oral verbal informed consent was obtained from every participant, and confidentiality was ensured.

AVAILABILITY OF DATA AND MATERIALS

The authors confirm that the data supporting the findings of this study are available within the article.

FUNDING

None.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

[1] Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2224-60.
[http://dx.doi.org/10.1016/S0140-6736(12)61766-8] [PMID: 23245609]
[2] Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 2009; 373(9682): 2223-33.
[http://dx.doi.org/10.1016/S0140-6736(09)60746-7] [PMID: 19560604]
[3] Kõks G, Fischer K, Kõks S. Smoking-related general and cause-specific mortality in Estonia. BMC Public Health 2017; 18(1): 34.
[http://dx.doi.org/10.1186/s12889-017-4590-3] [PMID: 28724413]
[4] Wysowski DK, Schober SE, Wise RP, Kopstein A. Mortality attributed to misuse of psychoactive drugs, 1979-88. Public Health Rep 1993; 108(5): 565-70.
[PMID: 8416115]
[5] Emad Hamdi NS. Albert Sedrak, Aref Khowailed, Nasser Loza, Menan Rabie, Hisham Ramy. Sociodemographic Indicators for Substance Use and Abuse in Egypt. J Addict Prev 2016; 4(1)
[6] Johnson K, Holder H, Ogilvie K, et al. A community prevention intervention to reduce youth from inhaling and ingesting harmful legal products. J Drug Educ 2007; 37(3): 227-47.
[http://dx.doi.org/10.2190/DE.37.3.b] [PMID: 18047181]
[7] Medina-Mora ME. Prevention of substance abuse: a brief overview. World Psychiatry 2005; 4(1): 25-30.
[PMID: 16633497]
[8] Das JK, Salam RA, Arshad A, Finkelstein Y, Bhutta ZA. Interventions for Adolescent Substance Abuse: An Overview of Systematic Reviews. J Adolesc Health 2016; 59(4S): S61-75.
[http://dx.doi.org/10.1016/j.jadohealth.2016.06.021] [PMID: 27664597]
[9] Johnson LA, Johnson RL, Portier RB. Current “legal highs”. J Emerg Med 2013; 44(6): 1108-15.
[http://dx.doi.org/10.1016/j.jemermed.2012.09.147] [PMID: 23528960]
[10] UNOoDa C. UNODC World Drug Report 2017. Crime UNOoDa, (ed). 2017.
[11] Corazza O, Demetrovics Z, van den Brink W, Schifano F. ‘Legal highs’ an inappropriate term for ‘Novel Psychoactive Drugs’ in drug prevention and scientific debate. Int J Drug Policy 2013; 24(1): 82-3.
[http://dx.doi.org/10.1016/j.drugpo.2012.06.005] [PMID: 22883544]
[12] Egyptian Fund to Fight and Treat Drug Addiction and Abuse. Ministry of Social Solidarity Available at: http://drugcontrol.org.eg/media/NewsList/Item_489
[13] Egyptian Fund to Fight and Treat Drug Addiction and Abuse. Ministry of Social Solidarity Available at: http://drugcontrol.org.eg/media/NewsList/Item_526
[14] Bonn-Miller MO, Zvolensky MJ. An evaluation of the nature of marijuana use and its motives among young adult active users. Am J Addict 2009; 18(5): 409-16.
[http://dx.doi.org/10.3109/10550490903077705] [PMID: 19874161]
[15] Haug NA, Padula CB, Sottile JE, Vandrey R, Heinz AJ, Bonn-Miller MO. Cannabis use patterns and motives: A comparison of younger, middle-aged, and older medical cannabis dispensary patients. Addict Behav 2017; 72: 14-20.
[http://dx.doi.org/10.1016/j.addbeh.2017.03.006] [PMID: 28340421]
[16] Cuttler C, Spradlin A. Measuring cannabis consumption: Psychometric properties of the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU). PLoS One 2017; 12(5): e0178194.
[http://dx.doi.org/10.1371/journal.pone.0178194] [PMID: 28552942]
[17] Borcherding MJ. Marijuana Use Among Community College Students: A Study of Academic and Social Involvement 2016.
[18] Lamy FR, Daniulaityte R, Nahhas RW, et al. Increases in synthetic cannabinoids-related harms: Results from a longitudinal web-based content analysis. Int J Drug Policy 2017; 44: 121-9.
[http://dx.doi.org/10.1016/j.drugpo.2017.05.007] [PMID: 28578250]
[19] Castaneto MS, Gorelick DA, Desrosiers NA, Hartman RL, Pirard S, Huestis MA. Synthetic cannabinoids: epidemiology, pharmacodynamics, and clinical implications. Drug Alcohol Depend 2014; 144: 12-41.
[http://dx.doi.org/10.1016/j.drugalcdep.2014.08.005] [PMID: 25220897]
[20] Egan KL, Suerken CK, Reboussin BA, et al. K2 and Spice use among a cohort of college students in southeast region of the USA. Am J Drug Alcohol Abuse 2015; 41(4): 317-22.
[http://dx.doi.org/10.3109/00952990.2015.1043438] [PMID: 26030768]
[21] Lee N, Boeri M. Managing Stigma: Women drug users and recovery services. Fusio 2017; 1(2): 65-94.
[PMID: 30140790]
[22] Ibrahim Y, Hussain SM, Alnasser S, Almohandes H, Sarhandi I. Patterns and sociodemographic characteristics of substance abuse in Al Qassim, Saudi Arabia: a retrospective study at a psychiatric rehabilitation center. Ann Saudi Med 2018; 38(5): 319-25.
[http://dx.doi.org/10.5144/0256-4947.2018.319] [PMID: 30284986]
[23] Becker JB, Hu M. Sex differences in drug abuse. Front Neuroendocrinol 2008; 29(1): 36-47.
[http://dx.doi.org/10.1016/j.yfrne.2007.07.003] [PMID: 17904621]
[24] Schepis TS, Desai RA, Cavallo DA, et al. Gender differences in adolescent marijuana use and associated psychosocial characteristics. J Addict Med 2011; 5(1): 65-73.
[http://dx.doi.org/10.1097/ADM.0b013e3181d8dc62] [PMID: 21769049]
[25] Hamdi E, Gawad T, Khoweiled A, et al. Lifetime prevalence of alcohol and substance use in Egypt: a community survey. Subst Abus 2013; 34(2): 97-104.
[http://dx.doi.org/10.1080/08897077.2012.677752] [PMID: 23577901]
[26] Gowing LR, Ali RL, Allsop S, et al. Global statistics on addictive behaviours: 2014 status report. Addiction 2015; 110(6): 904-19.
[http://dx.doi.org/10.1111/add.12899] [PMID: 25963869]
[27] West R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychol Health 2017; 32(8): 1018-36.
[http://dx.doi.org/10.1080/08870446.2017.1325890] [PMID: 28553727]
[28] Lai S, Lai H, Page JB, McCoy CB. The association between cigarette smoking and drug abuse in the United States. J Addict Dis 2000; 19(4): 11-24.
[http://dx.doi.org/10.1300/J069v19n04_02] [PMID: 11110061]
[29] Kandel ER, Kandel DB. Shattuck Lecture. A molecular basis for nicotine as a gateway drug. N Engl J Med 2014; 371(10): 932-43.
[http://dx.doi.org/10.1056/NEJMsa1405092] [PMID: 25184865]
[30] Agrawal A, Budney AJ, Lynskey MT. The co-occurring use and misuse of cannabis and tobacco: a review. Addiction 2012; 107(7): 1221-33.
[http://dx.doi.org/10.1111/j.1360-0443.2012.03837.x] [PMID: 22300456]
[31] Gunderson EW, Haughey HM, Ait-Daoud N, Joshi AS, Hart CL. A survey of synthetic cannabinoid consumption by current cannabis users. Subst Abus 2014; 35(2): 184-9.
[http://dx.doi.org/10.1080/08897077.2013.846288] [PMID: 24821356]
[32] Secades-Villa R, Garcia-Rodríguez O, Jin CJ, Wang S, Blanco C. Probability and predictors of the cannabis gateway effect: a national study. Int J Drug Policy 2015; 26(2): 135-42.
[http://dx.doi.org/10.1016/j.drugpo.2014.07.011] [PMID: 25168081]
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"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


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