Effects of an Awareness Enhancement Program on Adolescents’ Attitudes Toward Kratom Use

Abstract

Introduction Kratom is a group of psychoactive plants that has rapidly spread among adolescents, posing serious health risks. Its consumption can lead to severe physical and neurological complications, significantly increasing the risk of mortality. 

Objectives This study aimed 1) to compare adolescents’ attitudes toward kratom use within the experimental group at three time points: before the program, immediately after the program, and at a 4-week follow-up; and 2) to compare adolescents’ attitudes toward kratom use between the experimental and control groups at three time points: before the program, immediately after the program, and at a 4-week follow-up.

Research Design This study employed experimental design with a two-group repeated measures, integrating Gibson’s Empowerment theory, which consists of four key stages: 1) discovering reality, 2) critical reflection, 3) taking charge: making decisions, selecting appropriate activities, and taking action, and 4) holding on: maintaining effective practices. This process aims to foster individuals’ confidence in their inherent potential and capabilities, while also enhancing self-awareness. Self-awareness emerges through cognitive processes; when individuals engage in and are stimulated by these four stages, they acquire knowledge that ultimately leads to heightened self-awareness. Furthermore, self-awareness influences the ability to perceive and understand one’s thoughts, beliefs, and attitudes. Therefore, the development of self-awareness and empowerment can contribute to attitude transformation and the reduction of risk behaviors among adolescents.

Methods The sample in this study consisted of 50 students aged between 10 and 15 years, currently enrolled in extended opportunity schools in a northeastern province. Participants were randomly recruited through simple random sampling, then were randomly assigned into two groups: an experimental group (n = 25) and an a control group (n = 25). The experimental group participated in the program, while the control group received routine care. The instruments used in this study included: 1) a general information questionnaire, 2) a kratom use behavior questionnaire, and 3) an attitude assessment scale toward kratom use. The content was validated by five experts revealing the Index of Item Objective Congruence (IOC) of the attitude toward kratom use and the awareness-enhancement program for adolescent kratom use behavior at .79 and .93, respectively. The program consists of six activities conducted over approximately 18 days. Data analysis for general information employs descriptive statistics, including frequency, percentage, mean, and standard deviation. The mean attitudes toward kratom use are compared between the experimental and control groups using Two-way ANOVA with repeated measures analysis of variance. Pairwise comparisons are performed using Bonferroni.

Results The majority of participants were male (68%), with an average age of 12.68 years (SD = 1.62). The primary reason for initial kratom use was peer influence (56%). More than half of the participants consumed kratom in the form of extract (52%), and 60% obtained kratom through personal purchase. Within the experimental group, the mean score for perceived benefits of drug use was high before the program (M = 2.77, SD = 0.78), decreased to a low level immediately after the program (M = 2.23, SD = 0.58), and remained low at the 4-week follow-up (M = 2.02, SD = 0.57). Regarding the perceived impacts on physical health, finances, and family, the mean score was moderate before the program (M = 2.81, SD = 1.17), increased to a moderate level immediately after the program (M = 3.34, SD = 1.08), and reached a high level at the 4-week follow-up (M = 4.08, SD = 0.97). The desire to use kratom was moderate before the program (M = 2.65, SD = 1.00), decreased to a low level immediately after the program (M = 2.19, SD = 1.03), and remained low at the 4-week follow-up (M = 1.86, SD = 0.93). Two-way ANOVA with repeated measures analysis revealed statistically significant differences across time in the mean perceived benefits of drug use, perceived impacts on physical health, finances, and family, and desire to use kratom (F = 45.321, F = 38.651, and F = 42.108, respectively; p < .001). And when analyzing the results between the experimental group and the control group, it was found that there was a significant difference (F = 18.254, F = 22.485, F = 24.356 respectively, p < .001)

Recommendation The findings of this study indicate that an awareness enhancement program can effectively modify adolescents’ attitudes toward kratom use. Health professionals may adapt this program for use with adolescents who engage in forms of substance use, tailoring the content to suit the specific substance involved. Such adaptation can lead to sustainable outcomes and contribute to more effective prevention and intervention strategies for addressing substance use issues among adolescents.