Conduct Disorder and Its Associated Factors Among Governmental Secondary School Students in Dessie City, Northeast Ethiopia, a Cross-sectional Study

Conduct Disorder and Its Associated Factors Among Governmental Secondary School Students in Dessie City, Northeast Ethiopia, a Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Conduct Disorder and Its Associated Factors Among Governmental Secondary School Students in Dessie City, Northeast Ethiopia, a Cross-sectional Study Eyob Melesse, Jemal Seid, Betelhem Fikadu, Zelalem Birhan, Solomon Yimer, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6409604/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Introduction: Conduct disorder is a behavioral and mental health disorder that typically develops in childhood or adolescence and is characterized by a persistent pattern of violating the rights of others or social norms. It is linked with aggression towards people or animals, destruction of property, deceitfulness, or theft but little is known about conduct disorder among government secondary school students in Dessie City, Ethiopia. This study aimed to assess the magnitude of conduct disorder and its associated factors among secondary school students in Dessie City, Northeast Ethiopia. Methods An institution-based cross-sectional study design was conducted from June 1–30/ 2024. A multistage stratified sampling technique was used to select 570 government secondary school students. Data were collected using a self-administered questionnaire. A Disruptive Behavior Disorder (DBD) rating scale was used to measure conduct disorder among students. The collected data were coded and entered into Epi-data version 4.6 and then exported to SPSS version 26 for further analysis. Bivariable and multivariable logistic regressions with odds ratios (ORs) and 95% confidence interval (CIs) at p-value < 0.05 were employed as the result. Results The magnitude of conduct disorder among government secondary school students was 7.4% (95% CI: 5.3, 9.6). Approximately 87(15.3%) participants experienced moderate to high-stress levels, and 62(10.9%) experienced high levels of adverse childhood abuse. In multivariable logistic regression analyses, the associated factors for conduct disorder were being male (AOR = 2.519, 95% CI: 1.045–6.071), age category (16–18) (AOR = 4.07 95% CI:1.29–12.77), problematic substance use (AOR = 3.00, 95% CI: 1.31–6.91), adverse childhood abuse (AOR = 2.72 95CI: 1.02–7.26), maternal educational status (AOR = 4.33, 95% CI: 1.19–15.63) and permissive parenting style (AOR = 3.53, 95% CI:1.48–8.40). Conclusions The magnitude of conduct disorders among secondary school students in Dessie City was comparable to the estimated global prevalence rate. Being male, age category, problematic substance use, adverse childhood abuse, maternal educational status, and permissive parenting style were significantly associated with conduct disorders. Therefore, increasing parental knowledge and strengthening parental skills, advocating for mothers' education, and preventing substance use among students could help reduce youth’s conduct problems. Biological sciences/Psychology Health sciences/Medical research Conduct Disorder Dessie City Ethiopia Secondary School Students Figures Figure 1 INTRODUCTION Conduct disorder (CD) represents a spectrum of enduring behavioral patterns characterized by aggression, property destruction, deceitfulness, and violations of societal norms, constituting a significant challenge among pediatric and adolescent populations [ 1 ]. Conduct disorders may initiate during childhood and exhibit a life-course persistent trajectory, or may emerge during adolescence and display an adolescence-limited course [ 2 ]. The prevalence rates of conduct disorders vary significantly across nations [ 3 ]. A systematic review and meta-analysis indicated that the globally estimated pooled prevalence of conduct disorders among children and adolescents is approximately 8% within school populations [ 4 ]. On a global scale, CD is responsible for 5.26 million years of living with disabilities (YLDs)/disability-adjusted life years (DALYs), ranking as the 72nd leading cause of global DALYs and appearing among the top 15 contributors to morbidity in children aged 5–18 years [ 5 ]. In Europe, the pooled prevalence rate of conduct disorders is reported to be 1.5% [ 6 ]. A study conducted in China revealed that the prevalence of conduct disorder among juvenile delinquent adolescents from reformatory schools and correctional facilities was 57.09% and 60.07%, respectively [ 7 ]. A study conducted in the Kingdom of Saudi Arabia indicated that the prevalence of conduct disorder was 41.9% in the 17–18 age group and 25.6% in the 15–16 age group [ 8 ]. In the African context, the prevalence rates of conduct disorders among adolescents across various countries are divergent. Recent investigations conducted in Kenya and Nigeria revealed that the prevalence of conduct disorders was 31.4% [ 9 ] and 15.82% [ 10 ], respectively. In another study conducted among Secondary School adolescents and primary school children in Nigeria, the prevalence of CD was 14.5% [ 11 ] and 9.8% [ 12 ], respectively. A study conducted in Uganda revealed that the prevalence of conduct problems among primary school students ranged from 3–34% [ 13 ]. Although limited research has been conducted on conduct disorder among school students in Ethiopia, a study titled "Prevalence and correlates of internalizing and externalizing mental health problems among in-school adolescents in eastern Ethiopia" revealed that the prevalence of conduct problems was 32.83% [ 14 ]. In a study conducted in the Ambo district, the prevalence of conduct disorder among primary school students was 9.1% [ 15 ]. Demographic and socioeconomic factors have been associated with the development of conduct disorder among adolescents, as evidenced by different studies. Family history of psychiatric illness and parental antisocial behavior are risk factors for developing conduct behavior [ 16 ]. Male sex plays a major role in conductive behavior compared with female sex [ 9 , 11 , 17 ]. Family Dynamics: Dysfunctional family dynamics, including inconsistent discipline, harsh or permissive parenting styles, parental substance abuse (drinking alcohol, khat chewing, smoking cigarette), family financial status, family conflict, and disrupted family structures, increase the likelihood of CD in adolescents [ 18 , 19 ]. Adverse environmental conditions such as parenting style, perceived social support, exposure to violence, trauma, abuse (physical, emotional, or sexual), neglect, chaotic home environments, peer pressure, and community violence can increase the risk of conduct disorder in adolescents [ 20 ]. A study conducted among Iranian youth showed that the incidence of conduct disorder was markedly diminished among participants whose fathers and mothers possessed a high school diploma compared to those whose fathers and mothers were unable to read and write [ 21 ]. Children and adolescents diagnosed with conduct disorders are at markedly elevated risk of developing a spectrum of mental health disorders in adulthood. These disorders include anxiety, bipolar disorder, schizophrenia, substance use disorders, and antisocial personality disorders. Furthermore, individuals with a prior diagnosis of CD exhibit a heightened propensity to engage in criminal activities, experience escalated suicide risk, attain lower academic achievement, face unemployment, suffer from poor physical health, and face persistent psychosocial challenges [ 22 – 24 ]. If not adequately addressed, early onset CD can precipitate complications during adolescence, with approximately half of those affected resorting to substance abuse and partaking in criminal conduct [ 25 ]. Such behaviors can engender repeated conflicts with peers, educators, and family members, culminating in academic underperformance, school dropout, and subsequent mental health disorders later in life [ 26 ]. Rapid urbanization, pervasive poverty, and restricted access to mental health services are recognized as potential contributors to the incidence of CD [ 27 , 28 ]. Conversely, Ethiopia, Dessie City, is confronted with distinct socioeconomic challenges, exposure to violence, and trauma during civil wartime that may affect adolescent behavior. Therefore, this study aimed to assess the magnitude of conduct disorder and its associated factors among secondary school students in Dessie City, Ethiopia. METHODS All methods were carried out in accordance with relevant guidelines and regulations. Study Design and Setting An institution based cross-sectional study design was conducted among government secondary school student in Dessie City, South Wollo Zone, Northeast Ethiopia from June 1 to 30/2024. The City is located in the Amhara Region approximately 401 kilometers from the capital city, Addis Ababa. It is found at altitude between 2470 and 2550 meters above sea level. The City is subdivided into five sub cities: Hotie, Arada, Segnogebya, Menafesha and Buanbua wuha. The City has 26 kebeles (18 urban and 8 rurals). Dessie City has 619,199 total populations. Out of them 292,991 are males and 326,208 females according to Dessie City Administration report in 2024. There are ten governmental Secondary Schools (grade 9–12) in the city: Memher Akaleweld Secondary School, Boru Silase Secondary School, Hotie Secondary School, Kara Gutu Secondary School, Kidame Gebya Secondary School, Nigus Mickale Secondary School, Tita Secondary School, Kelem Meda Secondary School, Gerado Secondry School and Addis Hiowet Secondary school, and three private schools (Alif Secondary School, Catholic Kidanemiret Secondary School and Merkeze Alburhan Secondary School). There are 10,624 students from government schools and 1,270 students from private schools attending their education in 2023/2024 academic year. Of the total number of students, 5380 were female students. Participants A total of 570 government secondary school students aged less than or equal to 18-year-old were included in this study. The sample size for this study was determined using a single-population proportion formula. The following assumptions were made. Proportion of conduct disorder (9.1%) [ 15 ], confidence level (95%), margin of error (0.03), design effect (1.5), and no response rate (10%) of the sample size. Sampling Technique Multistage sampling techniques were used to select a representative sample of students from different government secondary schools in Dessie City. Three secondary schools were selected using the lottery method from ten secondary schools, and then again, we selected six grades from these three schools (from grade 9 to 12). From each grade, we also selected sections (50%) and proportionally allocated them for each grade. Finally, we selected students from each section using simple random sampling techniques (see Fig. 1 below). Data Collection Procedures and instrument Structured questionnaires were self-administered to collect data on students' conduct disorders and independent variables. We measured CD based on Diagnostic and statistical Manual of mental disorder, Fifth Edition Text Revision (DSM V TR), adapted from disruptive behavioral disorder (DBD) rating scale. The cutoff point for having conduct disorder was three or more from any category or combination [ 29 ]. This section is divided into four subscales representing the core symptom clusters for diagnosing CD: aggressive symptoms, destruction of property, deceitfulness and theft, and violation of societal rules. Test-retest and internal consistency were 0.85 and 0.89, respectively [ 30 ]. Social support was assessed using the three items from the Oslo Social Support Scale, with a total range of 3 to 14. Scores between 3 and 8 were categorized as indicating poor social support, scores range from 9 and 11 indicated moderate social support, and scores from 12 to 14 were considered strong social support [ 31 ]. Problematic substance use was assessed using the CAGE-AID questioner, which consisted of four questions. Participants who scored two or more positive answers were considered positive for problematic substance use. The internal consistency of the CAGE-AID is high for self-reporting (Cronbach alpha = 0.77) [ 32 ]. This tool was used in different settings in Ethiopian studies. Parenting style was assessed by using parenting style scale scores range from never to always. The highest score indicated a preferred parenting style [ 33 ]. It is a valid measurement tool with Cronbach alpha for authoritarian (0.81), authoritative (0.79) and permissive (0.86) [ 34 ]. Perceived Stress Scale (PSS) was used to assess student’s perceived stress level. It is a validated tool used in chronically ill patients to assess perceived stress level of the event or situation faced in the past month [ 35 ]. Each item is scored from 0 (never) to 5 (very often), with a total score ranging 0 to 40. Higher scores on this scale indicate a higher level of stress. Six items of the PSS-10 measure stress and four items measure coping strategies for stress. Adverse Childhood Experience (ACE) refers to traumatic events that occur during childhood, typically before age 18 years. ACE consists 10 items used to assess adverse Childhood experiences in individuals before age 18 years. Each Yes answer was assigned a score of 1. The total score (the sum of all YES answers) indicates the cumulative number of ACEs experienced by the individual. Higher scores were associated with an increased risk of negative health and social outcomes later in life. 0: low ACE, 1–3 intermediate ACE, above 3 high ACE [ 36 , 37 ]. Data quality Assurance To ensure the quality of the data, two data collectors and one supervisor were selected from psychiatry professionals. The principal investigators provided a one-day training for data collectors and supervisor. The questionnaires were translated to local Amharic language by language experts and back translated to English by an independent person to check for consistency and understandability of the tools; a pre-test was conducted on 5% (29) students of the sample at kombolcha town governmental secondary school for clarity of questionnaires one week prior to actual data collection to make an amendment. Regular supervision by the supervisor and principal investigators were ensured that all necessary data were properly collected. Data collection was processed promptly, entered into pi-data and exported to SPSS for analysis. Data Analysis process Data were coded and entered into EPI data Version 4.6. and exported to SPSS Version 26 for analysis. Descriptive statistics, including percentages, frequencies, means, and standard deviations, were used to describe the magnitude of CD. Bivariate logistic regression analysis was performed to determine each of explanatory variables, and variables with a p- value less than 0.25 during bivariate analysis were entered into multivariate logistic regression analysis. Multivariable binary logistic regression analysis was conducted to determine the presence of a statistically significant association between explanatory variables and outcome variable. A p-value less than 0.05 were considered statistically significant, and strength of the association was presented by odds ratio with 95% C.I. RESULTS Socio-demographic characteristics A total of 570 students (out of 582 participants) participated in this study, yielding a response rate of 97.9%. The majority of participants, 373 (63.5%), were male. Three-fourths of the participants, 430 (75.4%), were aged 16–18 years, with a mean age of 16.6 years (± 1.402 SD). Most participants’ parents resided in urban areas, 440 (77.2%). Of the participants, 368 (64.6%) reported having married parents, and more than half of the respondents, 344 (60.4%), lived in households with six or more family members (for additional details, see Table 1 ). Table 1 ; Socio-demographic characteristics of respondents among secondary schools students at Dessie Town, North East Ethiopia, 2024(n = 570). Variables Categories Frequency Percentage Age of students 14–15 140 24.6 16–18 430 75.4 Sex Male 373 65.4 Female 197 34.6 Number of family 1–5 Above 6 226 344 39.6 60.4 Grade levels Grade 9 113 19.8 Grade10 114 20.8 grade11 181 31.8 grade12 162 28.4 Parental marital status Married 368 64.6 Divorced 85 14.9 Widowed 79 13.9 Separated 38 6.7 Parental Residence urban rural 440 130 77.2 22.8 Living status with parents 359 63.0 Lonely 90 15.85 with friends 70 12.3 With wife/husband 51 8.9 Father educational status unable to read and write 33 5.8 able to read and write 49 8.6 grade 1–8 70 12.3 grade 9–12 42 7.4 colleges and above 376 66.0 Mother educational status unable to read and write 151 26.5 able to read and write 154 27.0 grade 1–8 35 6.1 grade 9–12 44 7.7 colleagues and above 186 32.6 Father occupational status merchant 220 38.6 Employed 153 26.8 Farmer 103 18.1 job less 54 9.5 Other* 40 7.0 Mother occupational status merchant 199 34.9 Employed 140 24.6 Farmer 87 15.3 Housewife 75 13.2 Other** 69 12.1 Other*: having private jobs, daily laborer others**: having private jobs, daily laborer, student Negative Life Events of Students and Their Parents The findings revealed several social and familial factors influencing student behavior. Among the participants, 52 (9.1%) reported that their mothers had a history of incarceration, while 37 (6.5%) indicated the same for their fathers. Additionally, 69 (12.1%) students experienced peer rejection. Notably, the vast majority of students, 555 (97.4%), reported no history of early childhood separation from their parents (For further detail, see Table 2 ). Table 2 Distributions of social and familial factors about conduct disorder among governmental secondary school students at Dessie City northeast Ethiopia 2024, (n = 570). Variable Categories Frequency Percentage Students’ mother history of Prison Yes 52 9.1 No 518 90.9 Students’ father history of prison Yes 37 6.5 No 533 93.5 History of rejections by peers/others Yes 69 12.1 No 501 87.9 Frequent use of social media (at least 3 days and above per week ) No 525 92.1 Yes 45 7.9 History of separation from parents during early childhood age No 555 97.4 Yes 15 2.6 Psychosocial Characteristics of the Students Nearly one-third of the students, 166 (29.1%), reported experiencing poor perceived social support. Additionally, 87 (15.3%) exhibited moderate-to-high stress levels, and 62 (10.9%) reported high levels of adverse childhood abuse. Regarding parenting styles, 96 students (16.8%) were categorized as having high authoritarian parents, 373 (65.4%) as having high authoritative parents, and 431 (75.6%) as having low permissive parents (for more detail, see Table 3 below). Table 3 Distributions of psychosocial characteristics among governmental secondary schools students in Dessie City North East Ethiopia, (n = 570). Variable Categories Frequency Percentage Perceived social support Poor 166 29.1 Moderate 113 19.8 Strong 291 51.1 Perceived stress level Low 483 84.7 Moderate-High 87 15.3 Adverse Childhood Abuse Low 424 74.7 Intermediate 82 14.4 High 62 10.9 Authoritarian parenting style Low 474 83.2 High 96 16.8 Authoritative parenting style Low 197 34.6 High 373 65.4 Permissive parenting style Low 431 75.6 High 139 24.4 Clinical and substance use-related problems of the students Almost one in ten students (54, 9.5%) reported that their family used substances like khat, cigarettes, and alcohol. About 74 (12.9%) of students were involved in problematic substance use, and half of them, 294 (51.9%), had ever used substances in their lifetime; whereas, one in five students, 127 (22.3%), were current substance users in the past three months. (for more information, see Table 4 below). Table 4 Clinical and substance related problems among governmental secondary school students in Dessie City North East Ethiopia, 2024. (n = 570) Variables Category Frequency Percent Family history of substance use (Khat, Smoking Cigarette, Alcohol) No 516 90.5 Yes 54 9.5 Family history of mental illness No 562 98.6 Yes 8 1.4 Problematic substance use No 496 87.1 Yes 74 12.9 Ever substance use No Yes 276 294 48.4 51.6 Current substance use No 443 77.7 Yes 127 22.3 Magnitude of conduct disorder among students The overall magnitude of conduct disorder in this study was 42 (7.4%) (95% CI; 5.3, 9.6). Among students who had conduct disorder, almost one third, 34 (36.6%), were often initiators of physical fights. In addition, 25 (39.1%), 21 (37.5%), and 26 (36.1%) were committed to physically cruel acts against people, deliberately destroying others’ property, and stealing nontrivial value items, respectively. From a total of conduct disorder, 25 (28.1%) often lie to obtain goods, and 30 (39.5%) often truancy from school (see Table 5 below). Table 5 Components of conduct disorder among governmental secondary school students at Dessie City Northeast Ethiopia, June 2024. (n = 570). Variables Categories Conduct disorder Yes No Broken into someone house, car Yes No 2(100.0%) 0(0.00%) 40(7.0%) 528(93.0%) Often initiates physical fights Yes No 34(36.6%) 59(63.4%) 8(1.7%) 469(98.3%) Has forced into sexual activity Yes No 6(27.3%) 16(72.7%) 36(6.6%) 512(93.4%) Often bullies, threaten or intermediates other Yes No 15(65.2%) 8(34.8%) 27(4.9%) 520(95.1%) Has physically cruel to animals Yes No 13(40.6%) 19(59.4%) 29(5.4%) 509(94.6%) Has stolen while confronting a victims Yes No 4(80.0%) 1(20.0%) 38(6.7%) 527(93.3%) Has physically cruel to people Yes No 25(39.1%) 39(60.9%) 17(3.4%) 489(96.6%) Has deliberately engaged in fire settings Yes No 7(63.6%) 4(36.4%) 35(6.3%) 524(93.7%) Has deliberately destroyed other property Yes No 21(37.5%) 35(52.5%) 21(4.1) 493(95.5%) Has stolen items that nontrivial value Yes No 26(36.1%) 46(63.9%) 16(3.2%) 482(96.8%) Often lies to obtain goods Yes No 25(28.1%) 64(71.9%) 17(3.5%) 464(96.5%)( Often stays out at night despite parental prohibited beginning before age 13 Yes No 19(35.2%) 35(64.8%) 23(4.5%) 493(95.5%) Often truants from school before age 13 Yes No 30(39.5%) 46(60.5%) 12(2.4%) 482(97.6%) Has run away from home overnight Yes No 5(38.5%) 8(61.5%) 37(6.6%) 520(93.4%) Has used weapon that cause serious physical harm to others Yes No 6(75.0%) 2(25.0%) 36(6.4%) 526(93.6%) Factors associated with conduct disorder The bivariate analysis showed that various socio-demographic, substance, and psychosocial-related factors were found to be associated with conduct disorder. Age, sex, grade level, maternal educational status, students current living status, permissive parenting style, current substance use, problematic substance use, adverse childhood experience, perceived stress level, and poor social support were significantly associated with conduct disorder. However, multivariable logistic regression showed that six variables were positively associated with conduct disorder. Being male (AOR = 2.519, 95% CI: 1.045–6.071, p = 0.040), unable to read and write maternal educational status (AOR = 4.333, 95% CI: 1.199–15.633, p = 0.025), high permissive parenting style (AOR = 3.537, 95% CI: 1.489–8.401, p = 0.004), high adverse childhood abuse (AOR = 2.721, 95% CI: 1.019–7.266, p = 0.046), problematic substance use (AOR = 3.004, 95% CI: 1.306–6.910, p = 0.010), and age group of 16–18 years old (AOR = 4.073, 95% CI: 1.298–12.779, p = 0.016) were significantly associated with conduct disorder in governmental secondary school students. Being male, they were more than 2.5 times more likely to have conduct disorder than females (AOR = 2.519, 95% CI: 1.045–6.071, p = 0.040). Unable to read and write, maternal educational status was more than 4.3 times more likely to have conduct disorder than having college and above levels of educational status (AOR = 4.333, 95% CI: 1.199–15.633, p = 0.025). Also, respondents whose age group was 16–18 were 4.1 times more likely to have conduct disorder than those whose age was less than 16 (AOR = 4.073, 95% CI: 1.298–12.779, p = 0.016). Students with a high permissive parenting style were 3.5 times more likely to develop conduct disorder than those students with a low permissive parenting style (AOR = 3.537, 95% CI: 1.489–8.401, p = 0.004). Students with problematic substance use were 3.0 times more likely to develop conduct disorder than those students with no problematic substance use (AOR = 3.004, 95% CI: 1.306–6.910, p = 0.010). Students with a high level of adverse childhood abuse were more than 2.7 times more likely to develop conduct disorder than those with a low level of adverse childhood abuse (AOR = 2.721, 95% CI: 1.019–7.266, p = 0.046) (see Table 6 below). Table 6 Bivariate and multivariate logistic regression analysis of factors associated with the conduct disorders among governmental secondary school students at Dessie City northeast Ethiopia, June 2024(n = 570). Variable Categories Conduct disorder Yes No COR AOR P-value Age 14–15 16–18 7(50%) 35(8.1%) 133(95.0%) 395(91.9%) 1 1.684(0.730–3.880) 1 4.073(1.298–12.779) 0.016* Sex Male Female 31(8.3%) 11(5.6%) 342(91.7%) 186(94.4%) 1.533(0.753–3.120) 1 2.519(1.045–6.071) 1 0.040* Residence Urban Rural 27(6.1%) 15(11.5%) 413(93.9%) 115(88.5%) 1 1.995(1.027–3.876) 1 1.910(.816 − 4.740) 0.136 Grade levels Grade 9 Grade 10 Grade 11 Grade 12 7(6.2%) 6(5.3%) 12(6.6%) 17(10.5%) 106(93.8%) 108(94.7%) 169(93.4%) 145(89.5%) 1 3.765(1.010-14.038) 3.967(1.131–13.920) 3.945(1.098–14.177) 1 2.099(0.435–10.139) 1.728(0.432–6.910) 2.457(0.672–8.989) 0.356 0.439 0.174 Perceived social support Poor Moderate Strong 18(10.8%) 11(9.7%) 13(4.5%) 148(89.2%) 102(90.3%) 278(95.5%) 2.505 (1.154–5.434) 3.180 (1.423–7.103) 1 1.937(0.800-4.691) 2.289(0.860–6.093) 1 0.143 0.098 Perceived stress level Low Moderate –high 32(6.2%) 12(13.8%) 453(93.8%) 75(86.2%) 1 2.416 (1.185–4.927) 1 1.409(0.540–3.678) 0.484 Adverse childhood abuse Low Intermediate High 23(5.4%) 11(13.4%) 8(12.9%) 403(94.6%) 71 (86.6%) 54 (87.1%) 1 2.715 (1.268–5.813) 2.596 (1.106–6.092) 1 2.464(0.933–6.093) 2.721(1.019–7.266) 0.069 0.046* Current living status With Parents With spouse With friends Lonely 25 (7.0%) 2(3.9%) 6(7.1%) 13(11.1%) 334(93.9%) 49(96.1%) 65(92.9) 80(88.9%) 1 0.5450.125–2.374) 1.028(0.379–2.783) 1.670(0.771–3.617) 1 0.572(0.095–3.453) 1.090(0.290–4.092) 1.441(0.536–3.873) 0.543 0.898 0.469 Mother Educational status Unable to read & write Able to read & write Grade 1–8 Grade 9–12 College & above 18(11.9%) 14(9.1%) 2(5.7%) 4(2.2%) 4(2.2%) 133(88.1%) 140(90.9%) 33(94.3%) 40(90.9%) 182(97.8%) 6.158(2.037–18.615) 4.550(1.466–14.125) 2.758(0.485–15.670) 4.550(1.092–18.966) 1 4.333(1.199–15.653) 3.190(0.923–11.030) 2.181(0.330-14.397) 2.000(0.378–10.589) 1 0.025* 0.067 0.418 0.415 Current substance use No Yes 29(6.5%) 23(10.2%) 414(93.5%) 114(89.8%) 1 0.614(0.309–1.220) 1 0.612(0.241–1.554) 0.301 Permissive parenting style Low High 25(5.8%) 17(12.2%) 406(94.2%) 122(87.8%) 1 2.263(1.183–4.328) 1 3.537(1.489–8.401) 0.004* Problematic substance use No Yes 18(3.6%) 8(10.9%) 478(96.4%) 66(89.1%) 1 3.219(1.565–6.743) 1 3.004(1.306–6.910) 0.010* Key: * = p value < 0.05 DISCUSSIONS This study indicated that the magnitude of conduct disorder was 7.4% among government secondary school students in Dessie City, Ethiopia. This study finding is consistent with the study conducted in the USA [ 38 ], Japan [ 39 ], and Ethiopia (among primary school students) [ 15 ]. However, conduct disorder in this study is lower than the study done in the United Kingdom (16%) [ 40 ] and in Nigeria (9.8%) [ 12 ], 14.5% [ 11 ]. This could be due to the sample size, socio-cultural differences, and differences in study design. Cohort study design was used in the United Kingdom, and the Vanderbilt Attention-Deficit Hyperactivity Disorder Diagnostic Teacher Rating Scale was used to assess conduct disorder, and a large sample size was used in Nigeria (1174), whereas our study utilized disruptive behavioral disorder tools to assess conduct disorder and a cross-sectional study design. In addition, it was also lower than the study conducted in Kenya (31.4%) [ 41 ] and China (58.72%) [ 42 ]. This discrepancy could probably be due to the sampling techniques, the purposive sampling technique used in Kenya, and the study populations difference focused on correctional facilities and juvenile homes, environments that can significantly impact behaviors and attitudes in China, which could increase the conduct disorder rates. The current study finding is slightly higher than studies done in India (5.48%) [ 43 ], (4.58%) [ 44 ], (3.0%) [ 45 ], and in Uganda (2%) [ 46 ]. The difference could be due to their difference in age of students included in the study, socio-culture, screening tools, and sample size difference. Conduct disorders were associated with being a male, an age group of 16-18-year-olds, a high level of adverse childhood abuse, problematic substance use, maternal educational status (unable to read and write), and a high permissive parenting style. The odds of developing conduct disorder are higher among male students as compared to female students. This is in line with studies conducted in Nigeria [ 47 ] and Kenya [ 41 ]. Behaviors such as unapproved absences from school, fighting, possession of dangerous weapons, vandalism of school property, bullying, theft, reckless driving, cheating, selling stolen goods, throwing objects at others, jumping school fences, and involvement in school riots are common among male students [ 47 ]. Conversely, the patterns of conduct disorder among female students are characterized by behaviors such as gossiping, engaging in sexual immorality, tearing examination reports, verbally abusing teachers and parents, and watching pornographic content. Students in the age group 16–18 years old were more likely to develop conduct disorder than students with lower ages (14–15). This finding is in line with the study done in Kenya [ 9 ] and Ethiopia [ 15 ]. This could be related to the fact that as adolescents mature, they become involved in violent groups and substance abuse, getting more freedom, which enables them to engage in more severe conduct issues, such as theft or assault. This indicates that the maturity level of students plays a significant role in their behavior. Such patterns may be linked to the biological and social changes that occur during a child's development [ 48 ]. In addition, environmental factors may play a role; experiencing civil war in the study area and witnessing bad behaviors from militants and being influenced by peer relationships may lead to various behavioral problems, including smoking, fighting, and involvement in gangs. Furthermore, increased freedom to leave the home exposes them to potentially harmful relationships [ 49 ]. This study showed that the magnitude of conduct disorder among secondary school students was higher among students whose maternal education is illiterate (unable to read and write). This finding is consistent with the study conducted in Tehran city [ 50 ]. Mothers often have more interaction with children to address educational, behavioral, and emotional issues. Consequently, it is reasonable to conclude that maternal educational status negatively influences the quality of child-rearing. High permissive parenting styles were riskier to develop conduct disorder in their children than low permissive parenting styles. This finding is consistent with the study conducted in Nigeria [ 51 ] and Ethiopia [ 15 ]. Parents play a crucial role in shaping their children's mental, emotional, and behavioral development, preparing them for adulthood. Once children begin school, parents are typically responsible for overseeing their conduct, education, and homework. They also collaborate with school authorities to address any educational, behavioral, or emotional challenges. Consequently, it is evident that a family's parenting style directly influences the overall quality of child-rearing. In addition, children raised in a negligent-permissive parenting style often exhibit immaturity, poor impulse control, and a lack of responsibility. As they enter adolescence, these tendencies can lead to increased impulsivity and behaviors such as drug use [ 51 ]. In this study, students with a high level of adverse childhood experiences were more likely to develop conduct disorder. This finding is consistent with a study done in Slovakia [ 52 ] and China [ 53 ]. Experiencing traumatic events during childhood can lead to significant distress, which is often linked to emotional and behavioral problems. This distress may result in lasting changes in the nervous system. Furthermore, it's likely that these adverse childhood experiences (ACEs) persist into adolescence, continuing to exert a direct and immediate impact on individuals [ 52 ]. In addition, exposure to high levels of conflict or violence between caregivers can normalize aggressive behaviors and disrupt emotional development, and unpredictable responses from caregivers can lead to confusion and frustration and increase the likelihood of conduct issues [ 54 ]. Students with problematic substance use were more likely to have conduct disorder. This finding is in line with a study conducted in the USA [ 55 ]. This could be due to substances that can alter brain chemistry, which is responsible for decision-making and impulse control, so early-onset substance use poses serious challenges for both individuals and society for students, like impulsivity, irritability, and potentially resulting in violent behaviors. Despite this study showing the magnitude of conduct disorder and its associated factors among secondary school students, it has limitations. Students and their parents might forget the childhood experiences and might not respond to some socially sensitive situations, like substance and sexual-related questions. In addition, this study was limited to school adolescents and youths; it might miss those adolescents and youths with conduct disorder in the community. As a result, these could minimize the magnitude of conduct disorder. CONCLUSIONS The magnitude of conduct disorder among secondary school students in Dessie City, Ethiopia, was comparable with the global estimated prevalence rate. Being male, in the age category (16-18-year-old), problematic substance use, adverse childhood abuse, students’ maternal educational status, and permissive parenting style were significantly associated with conduct disorder. Therefore, increasing parental knowledge and strengthening parental skills, advocating for mother education, and preventing childhood abuse and substance use among students could help to reduce students’ conduct behaviors. Alongside strengthening school student counseling and help-seeking attitude, contribute to resilience and control impulses. LIST OF ABBREVIATIONS AOR Adjusted Odds Ratio CD Conduct Disorder CAGE Cut Down, Annoyed, Guilty Feeling, Eye opener CI Confidence Interval COR Crude Odds Ratio DBD Disruptive Behavioral Disorder IERC Institutional Ethical Review Committee PSS Parenting Style Scale SPSS Statistical Package for Social Science OSLO-3 Oslo Social Support scale-3 Declarations Ethics approval and consent to participate All methods were carried out in accordance with relevant guidelines and regulations. Ethical approval was approved by Wollo University, Institutional Ethical Review Committee (IERC) of College of Medicine and Health sciences, Wollo Tertiary Care and Teaching Hospital, Tertiary Care campus. Ethical approval letter was given for all selected school directors and permission was obtained from Dessie City administration education bureau and selected schools before data collection. Written informed consent was obtained from each selected grade and section representative teachers and students’ parent before data collections. Ensuring they understand the study's purpose, procedures, and confidentiality measures. Data confidentiality and anonymity were maintained throughout the study, with strict data security measures in place. The study strictly follows ethical guidelines from Wollo University, prioritizing participant safety and privacy. Study participants having three yes answers and above from conduct disorder measurement tools adapted from DBD were referred to Dessie Comprehensive Specialized Hospital, the nearby hospital, for further evaluation and managements of their behaviors. Consent for publication Our manuscript doesn’t contain any individual person’s data in any form (including individual details, images or videos). So, the consent for publication is “ Not applicable ” in this section. Competing interests The authors declare that they have no conflicts of interest. Funding Not applicable Author Contribution EM, MS and JS designed and supervised the study, carried out the analysis, and interpreted the data; BF, ZB, SY, TA, MSH, AB, BY, HG, YZ and TA assisted in the design, analysis, and interpretation of the data; and MS wrote the manuscript. All authors contributed toward data analysis, drafting, and critically revising the paper and agree to be accountable for all aspects of the work. Acknowledgement We would like to thank Wollo University College of Medicine and Health Sciences and Dessie City Educational Office for their cooperation and assistance throughout the study process. Data Availability All data analyzed during this study are included in this manuscript article. The data sets used and analyzed during the current study are available from the corresponding author [Muhammed Seid, Email: [email protected] ;Mobile: +2519–13163924, Wollo University, Dessie, Ethiopia], on reasonable request. References Vahia, V. N. Diagnostic and statistical manual of mental disorders 5: A quick glance. Indian J. psychiatry . 55 (3), 220–223 (2013). Moore, A. A., Silberg, J. L., Roberson-Nay, R. & Mezuk, B. Life course persistent and adolescence limited conduct disorder in a nationally representative US sample: prevalence, predictors, and outcomes. Soc. Psychiatry Psychiatr. Epidemiol. 52 , 435–443 (2017). Bachmann, C. J. et al. Recognition and management of children and adolescents with conduct disorder: a real-world data study from four western countries. Child Adolesc. Psychiatry Mental Health . 18 (1), 18 (2024). Wu, J. et al. Trends in the prevalence of conduct disorder from 1990 to 2019: Findings from the Global Burden of Disease Study 2019. Psychiatry Res. 317 , 114907 (2022). Erskine, H. E. et al. The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. J. Child Psychol. Psychiatry . 55 (4), 328–336 (2014). Sacco, R., Camilleri, N. & Umla-Runge, K. The prevalence of conduct disorders among young people in europe: A systematic review and meta-analysis. Eur. Psychiatry . 64 (S1), S637–S638 (2021). Xie, Q. et al. The prevalence and risk factors of conduct disorder among juvenile delinquents in China. Humanit. Social Sci. Commun. 11 (1), 1–9 (2024). Mansor, K. A. et al. Associated Factors of Conduct Disorder among School Students. Am. J. Med. Sci. 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The consequences of conduct disorder for males who develop schizophrenia: associations with criminality, aggressive behavior, substance use, and psychiatric services. Schizophr. Res. 78 (2–3), 323–335 (2005). Erskine, H. E. et al. Long-term outcomes of attention-deficit/hyperactivity disorder and conduct disorder: a systematic review and meta-analysis. J. Am. Acad. Child. Adolesc. Psychiatry . 55 (10), 841–850 (2016). Olino, T. M., Seeley, J. R. & Lewinsohn, P. M. Conduct disorder and psychosocial outcomes at age 30: early adult psychopathology as a potential mediator. J. Abnorm. Child. Psychol. 38 (8), 1139–1149 (2010). Vandoni, M., D'Avanzo, B. & Barbato, A. The transition towards community-based mental health care in the European Union: Current realities and prospects. Health Policy . 144 , 105081 (2024). Dashiff, C., DiMicco, W., Myers, B. & Sheppard, K. Poverty and adolescent mental health. J. Child. Adolesc. Psychiatric Nurs. 22 (1), 23–32 (2009). Milone, A. & Sesso, G. 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Assessment of parenting practices and styles and adolescent sexual behavior among high school adolescents in Addis Ababa, Ethiopia. Lee, E. H., Chung, B. Y., Suh, C. H. & Jung, J. Y. K orean versions of the P erceived S tress S cale (PSS-14, 10 and 4): psychometric evaluation in patients with chronic disease. Scand. J. Caring Sci. 29 (1), 183–192 (2015). Anda, R. F. et al. Adverse childhood experiences and smoking during adolescence and adulthood. Jama 282 (17), 1652–1658 (1999). Tsehay, M., Necho, M., Belete, A. & Mekonnen, W. Adverse childhood experiences and their Alcohol, and chat Consumption among school-going adolescents, Ethiopia: Cross-sectional study. Archives Psychiatry Mental Health . 4 (1), 076–83 (2020). Ghandour, R. M. et al. Prevalence and treatment of depression, anxiety, and conduct problems in US children. J. Pediatr. 206 , 256–267 (2019). Yousefi, F. & Hoshiari, S. Prevalence of conduct disorder and associated factors among the high school students in Sanandaj, 2013. J. Kermanshah Univ. Med. Sci. ; 19 (1). (2015). Blakey, R. et al. Prevalence of conduct problems and social risk factors in ethnically diverse inner-city schools. BMC public. health . 21 , 1–3 (2021). Gitonga, M., Muriungi, S., Ongaro, K. & Omondi, M. Prevalence of conduct disorder among adolescents in secondary schools: a case of kamukunji and olympic mixed sub-county secondary schools in Nairobi County, Kenya. Xie, Q. et al. The prevalence and risk factors of conduct disorder among juvenile delinquents in China. Humanit. Social Sci. Commun. 11 (1), 1–9 (2024). Mishra, N., Mishra, A. & Dwivedi, R. Prevalence of conduct disorder in primary school children of rural Area. J. Evolut Med. Dent. Sci. 4 , 1917–1922 (2015). Sarkhel, S., Sinha, V. K., Arora, M. & DeSarkar, P. Prevalence of conduct disorder in schoolchildren of Kanke. Indian J. psychiatry . 48 (3), 159–164 (2006). Chandrasekar, S. Prevalence of Mental Health Problems among School-going Adolescents in Melmaruvathur: An Observational Study. Apollo Med. 21 (1), 22–25 (2024). Kivumbi, A. et al. Prevalence of behavioral disorders and attention deficit/hyperactive disorder among school going children in Southwestern Uganda. BMC psychiatry . 19 , 1–8 (2019). Rogo, I. S. & Garba, A. M. Gender difference in the prevalence and pattern of conduct disorder among adolescent students of senior secondary schools in Dala Education Zone, Kano State-Nigeria. J. Teach. Teacher Educ. 6 (01), 35–45 (2018). American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5 (American psychiatric association, 2013). Fairchild, G. et al. Conduct disorder. Nat. Reviews Disease Primers . 5 (1), 43 (2019). Azadyekta, M. Prevalence of conduct disorder among elementary students in Tehran city. Procedia-Social Behav. Sci. 29 , 693–702 (2011). Kumuyi, D. O., Akinnawo, E. O., Akintola, A. A., Akpunne, B. C. & Onisile, D. F. Parental factors as determinants of conduct disorder among in-school adolescents in Ibadan Metropolis. Nigeria Psychol. 12 (4), 643–659 (2021). Lackova Rebicova, M. et al. The number of adverse childhood experiences is associated with emotional and behavioral problems among adolescents. Int. J. Environ. Res. Public Health . 16 (13), 2446 (2019). Tian, M. & Motevalli, S. The Relationship between Adverse Childhood Experiences and Conduct Disorder among Primary School Students. Int. J. School Health . 11 (4), 221–231 (2024). Ojuope, A. Parental attachment, physical abuse and conduct disorder among secondary school adolescents in Ondo State, Nigeria. J. Psychiatry . 24 , p466 (2021). Krohn, M. D., Larroulet, P., Thornberry, T. P. & Loughran, T. A. The effect of childhood conduct problems on early onset substance use: An examination of the mediating and moderating roles of parenting styles. J. Drug Issues . 49 (1), 139–162 (2019). 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Conduct disorders may initiate during childhood and exhibit a life-course persistent trajectory, or may emerge during adolescence and display an adolescence-limited course [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe prevalence rates of conduct disorders vary significantly across nations [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A systematic review and meta-analysis indicated that the globally estimated pooled prevalence of conduct disorders among children and adolescents is approximately 8% within school populations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. On a global scale, CD is responsible for 5.26\u0026nbsp;million years of living with disabilities (YLDs)/disability-adjusted life years (DALYs), ranking as the 72nd leading cause of global DALYs and appearing among the top 15 contributors to morbidity in children aged 5\u0026ndash;18 years [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Europe, the pooled prevalence rate of conduct disorders is reported to be 1.5% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A study conducted in China revealed that the prevalence of conduct disorder among juvenile delinquent adolescents from reformatory schools and correctional facilities was 57.09% and 60.07%, respectively [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A study conducted in the Kingdom of Saudi Arabia indicated that the prevalence of conduct disorder was 41.9% in the 17\u0026ndash;18 age group and 25.6% in the 15\u0026ndash;16 age group [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the African context, the prevalence rates of conduct disorders among adolescents across various countries are divergent. Recent investigations conducted in Kenya and Nigeria revealed that the prevalence of conduct disorders was 31.4% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and 15.82% [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], respectively. In another study conducted among Secondary School adolescents and primary school children in Nigeria, the prevalence of CD was 14.5% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and 9.8% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], respectively. A study conducted in Uganda revealed that the prevalence of conduct problems among primary school students ranged from 3\u0026ndash;34% [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough limited research has been conducted on conduct disorder among school students in Ethiopia, a study titled \"Prevalence and correlates of internalizing and externalizing mental health problems among in-school adolescents in eastern Ethiopia\" revealed that the prevalence of conduct problems was 32.83% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In a study conducted in the Ambo district, the prevalence of conduct disorder among primary school students was 9.1% [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDemographic and socioeconomic factors have been associated with the development of conduct disorder among adolescents, as evidenced by different studies. Family history of psychiatric illness and parental antisocial behavior are risk factors for developing conduct behavior [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Male sex plays a major role in conductive behavior compared with female sex [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Family Dynamics: Dysfunctional family dynamics, including inconsistent discipline, harsh or permissive parenting styles, parental substance abuse (drinking alcohol, khat chewing, smoking cigarette), family financial status, family conflict, and disrupted family structures, increase the likelihood of CD in adolescents [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Adverse environmental conditions such as parenting style, perceived social support, exposure to violence, trauma, abuse (physical, emotional, or sexual), neglect, chaotic home environments, peer pressure, and community violence can increase the risk of conduct disorder in adolescents [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A study conducted among Iranian youth showed that the incidence of conduct disorder was markedly diminished among participants whose fathers and mothers possessed a high school diploma compared to those whose fathers and mothers were unable to read and write [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eChildren and adolescents diagnosed with conduct disorders are at markedly elevated risk of developing a spectrum of mental health disorders in adulthood. These disorders include anxiety, bipolar disorder, schizophrenia, substance use disorders, and antisocial personality disorders. Furthermore, individuals with a prior diagnosis of CD exhibit a heightened propensity to engage in criminal activities, experience escalated suicide risk, attain lower academic achievement, face unemployment, suffer from poor physical health, and face persistent psychosocial challenges [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. If not adequately addressed, early onset CD can precipitate complications during adolescence, with approximately half of those affected resorting to substance abuse and partaking in criminal conduct [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Such behaviors can engender repeated conflicts with peers, educators, and family members, culminating in academic underperformance, school dropout, and subsequent mental health disorders later in life [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Rapid urbanization, pervasive poverty, and restricted access to mental health services are recognized as potential contributors to the incidence of CD [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Conversely, Ethiopia, Dessie City, is confronted with distinct socioeconomic challenges, exposure to violence, and trauma during civil wartime that may affect adolescent behavior. Therefore, this study aimed to assess the magnitude of conduct disorder and its associated factors among secondary school students in Dessie City, Ethiopia.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e All methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eAn institution based cross-sectional study design was conducted among government secondary school student in Dessie City, South Wollo Zone, Northeast Ethiopia from June 1 to 30/2024. The City is located in the Amhara Region approximately 401 kilometers from the capital city, Addis Ababa. It is found at altitude between 2470 and 2550 meters above sea level. The City is subdivided into five sub cities: Hotie, Arada, Segnogebya, Menafesha and Buanbua wuha. The City has 26 kebeles (18 urban and 8 rurals). Dessie City has 619,199 total populations. Out of them 292,991 are males and 326,208 females according to Dessie City Administration report in 2024. There are ten governmental Secondary Schools (grade 9\u0026ndash;12) in the city: Memher Akaleweld Secondary School, Boru Silase Secondary School, Hotie Secondary School, Kara Gutu Secondary School, Kidame Gebya Secondary School, Nigus Mickale Secondary School, Tita Secondary School, Kelem Meda Secondary School, Gerado Secondry School and Addis Hiowet Secondary school, and three private schools (Alif Secondary School, Catholic Kidanemiret Secondary School and Merkeze Alburhan Secondary School). There are 10,624 students from government schools and 1,270 students from private schools attending their education in 2023/2024 academic year. Of the total number of students, 5380 were female students.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eA total of 570 government secondary school students aged less than or equal to 18-year-old were included in this study. The sample size for this study was determined using a single-population proportion formula. The following assumptions were made.\u003c/p\u003e\u003cp\u003eProportion of conduct disorder (9.1%) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], confidence level (95%), margin of error (0.03), design effect (1.5), and no response rate (10%) of the sample size.\u003c/p\u003e\n\u003ch3\u003eSampling Technique\u003c/h3\u003e\n\u003cp\u003eMultistage sampling techniques were used to select a representative sample of students from different government secondary schools in Dessie City. Three secondary schools were selected using the lottery method from ten secondary schools, and then again, we selected six grades from these three schools (from grade 9 to 12). From each grade, we also selected sections (50%) and proportionally allocated them for each grade. Finally, we selected students from each section using simple random sampling techniques (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eData Collection Procedures and instrument\u003c/h3\u003e\n\u003cp\u003eStructured questionnaires were self-administered to collect data on students' conduct disorders and independent variables. We measured CD based on Diagnostic and statistical Manual of mental disorder, Fifth Edition Text Revision (DSM V TR), adapted from disruptive behavioral disorder (DBD) rating scale. The cutoff point for having conduct disorder was three or more from any category or combination [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This section is divided into four subscales representing the core symptom clusters for diagnosing CD: aggressive symptoms, destruction of property, deceitfulness and theft, and violation of societal rules. Test-retest and internal consistency were 0.85 and 0.89, respectively [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSocial support was assessed using the three items from the Oslo Social Support Scale, with a total range of 3 to 14. Scores between 3 and 8 were categorized as indicating poor social support, scores range from 9 and 11 indicated moderate social support, and scores from 12 to 14 were considered strong social support [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eProblematic substance use was assessed using the CAGE-AID questioner, which consisted of four questions. Participants who scored two or more positive answers were considered positive for problematic substance use. The internal consistency of the CAGE-AID is high for self-reporting (Cronbach alpha\u0026thinsp;=\u0026thinsp;0.77) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This tool was used in different settings in Ethiopian studies.\u003c/p\u003e\u003cp\u003eParenting style was assessed by using parenting style scale scores range from never to always. The highest score indicated a preferred parenting style [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. It is a valid measurement tool with Cronbach alpha for authoritarian (0.81), authoritative (0.79) and permissive (0.86) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePerceived Stress Scale (PSS) was used to assess student\u0026rsquo;s perceived stress level. It is a validated tool used in chronically ill patients to assess perceived stress level of the event or situation faced in the past month [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Each item is scored from 0 (never) to 5 (very often), with a total score ranging 0 to 40. Higher scores on this scale indicate a higher level of stress. Six items of the PSS-10 measure stress and four items measure coping strategies for stress.\u003c/p\u003e\u003cp\u003eAdverse Childhood Experience (ACE) refers to traumatic events that occur during childhood, typically before age 18 years. ACE consists 10 items used to assess adverse Childhood experiences in individuals before age 18 years. Each Yes answer was assigned a score of 1. The total score (the sum of all YES answers) indicates the cumulative number of ACEs experienced by the individual. Higher scores were associated with an increased risk of negative health and social outcomes later in life. 0: low ACE, 1\u0026ndash;3 intermediate ACE, above 3 high ACE [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eData quality Assurance\u003c/h3\u003e\n\u003cp\u003eTo ensure the quality of the data, two data collectors and one supervisor were selected from psychiatry professionals. The principal investigators provided a one-day training for data collectors and supervisor. The questionnaires were translated to local Amharic language by language experts and back translated to English by an independent person to check for consistency and understandability of the tools; a pre-test was conducted on 5% (29) students of the sample at kombolcha town governmental secondary school for clarity of questionnaires one week prior to actual data collection to make an amendment. Regular supervision by the supervisor and principal investigators were ensured that all necessary data were properly collected. Data collection was processed promptly, entered into pi-data and exported to SPSS for analysis.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis process\u003c/h2\u003e\u003cp\u003eData were coded and entered into EPI data Version 4.6. and exported to SPSS Version 26 for analysis. Descriptive statistics, including percentages, frequencies, means, and standard deviations, were used to describe the magnitude of CD. Bivariate logistic regression analysis was performed to determine each of explanatory variables, and variables with a p- value less than 0.25 during bivariate analysis were entered into multivariate logistic regression analysis. Multivariable binary logistic regression analysis was conducted to determine the presence of a statistically significant association between explanatory variables and outcome variable. A p-value less than 0.05 were considered statistically significant, and strength of the association was presented by odds ratio with 95% C.I.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographic characteristics\u003c/h2\u003e\u003cp\u003eA total of 570 students (out of 582 participants) participated in this study, yielding a response rate of 97.9%. The majority of participants, 373 (63.5%), were male. Three-fourths of the participants, 430 (75.4%), were aged 16\u0026ndash;18 years, with a mean age of 16.6 years (\u0026plusmn;\u0026thinsp;1.402 SD).\u003c/p\u003e\u003cp\u003eMost participants\u0026rsquo; parents resided in urban areas, 440 (77.2%). Of the participants, 368 (64.6%) reported having married parents, and more than half of the respondents, 344 (60.4%), lived in households with six or more family members (for additional details, see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e; Socio-demographic characteristics of respondents among secondary schools students at Dessie Town, North East Ethiopia, 2024(n\u0026thinsp;=\u0026thinsp;570).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAge of students\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u0026ndash;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e430\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e75.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e373\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e65.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\u003cp\u003eAbove 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e226\u003c/p\u003e\u003cp\u003e344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39.6\u003c/p\u003e\u003cp\u003e60.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eGrade levels\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egrade11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egrade12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eParental marital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e64.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSeparated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParental Residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003cp\u003erural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e440\u003c/p\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e77.2\u003c/p\u003e\u003cp\u003e22.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eLiving status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ewith parents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e359\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e63.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLonely\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ewith friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith wife/husband\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eFather educational status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eunable to read and write\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eable to read and write\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egrade 1\u0026ndash;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egrade 9\u0026ndash;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecolleges and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e376\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eMother educational status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eunable to read and write\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eable to read and write\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egrade 1\u0026ndash;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egrade 9\u0026ndash;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecolleagues and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eFather occupational status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emerchant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ejob less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eMother occupational status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emerchant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e199\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eOther*: having private jobs, daily laborer\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eothers**: having private jobs, daily laborer, student\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eNegative Life Events of Students and Their Parents\u003c/h2\u003e\u003cp\u003eThe findings revealed several social and familial factors influencing student behavior. Among the participants, 52 (9.1%) reported that their mothers had a history of incarceration, while 37 (6.5%) indicated the same for their fathers. Additionally, 69 (12.1%) students experienced peer rejection. Notably, the vast majority of students, 555 (97.4%), reported no history of early childhood separation from their parents (For further detail, see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistributions of social and familial factors about conduct disorder among governmental secondary school students at Dessie City northeast Ethiopia 2024, (n\u0026thinsp;=\u0026thinsp;570).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStudents\u0026rsquo; mother history of Prison\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e518\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e90.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStudents\u0026rsquo; father history of prison\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e93.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHistory of rejections by peers/others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e87.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFrequent use of social media (at least 3 days and above per week\u0026nbsp;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e525\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e92.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHistory of separation from parents during early childhood age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e555\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e97.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePsychosocial Characteristics of the Students\u003c/h2\u003e\u003cp\u003eNearly one-third of the students, 166 (29.1%), reported experiencing poor perceived social support. Additionally, 87 (15.3%) exhibited moderate-to-high stress levels, and 62 (10.9%) reported high levels of adverse childhood abuse. Regarding parenting styles, 96 students (16.8%) were categorized as having high authoritarian parents, 373 (65.4%) as having high authoritative parents, and 431 (75.6%) as having low permissive parents (for more detail, see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e below).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistributions of psychosocial characteristics among governmental secondary schools students in Dessie City North East Ethiopia, (n\u0026thinsp;=\u0026thinsp;570).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePerceived stress level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e483\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e84.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate-High\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAdverse Childhood Abuse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e424\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e74.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAuthoritarian parenting style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e83.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAuthoritative parenting style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e373\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e65.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePermissive parenting style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e431\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e75.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eClinical and substance use-related problems of the students\u003c/h2\u003e\u003cp\u003eAlmost one in ten students (54, 9.5%) reported that their family used substances like khat, cigarettes, and alcohol. About 74 (12.9%) of students were involved in problematic substance use, and half of them, 294 (51.9%), had ever used substances in their lifetime; whereas, one in five students, 127 (22.3%), were current substance users in the past three months.\u003c/p\u003e\u003cp\u003e(for more information, see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e below).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical and substance related problems among governmental secondary school students in Dessie City North East Ethiopia, 2024. (n\u0026thinsp;=\u0026thinsp;570)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFamily history of substance use (Khat, Smoking Cigarette, Alcohol)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e516\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e90.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFamily history of mental illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e562\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e98.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eProblematic substance use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e496\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e87.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEver substance use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e276\u003c/p\u003e\u003cp\u003e294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.4\u003c/p\u003e\u003cp\u003e51.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCurrent substance use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e443\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e77.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eMagnitude of conduct disorder among students\u003c/h2\u003e\u003cp\u003eThe overall magnitude of conduct disorder in this study was 42 (7.4%) (95% CI; 5.3, 9.6). Among students who had conduct disorder, almost one third, 34 (36.6%), were often initiators of physical fights. In addition, 25 (39.1%), 21 (37.5%), and 26 (36.1%) were committed to physically cruel acts against people, deliberately destroying others\u0026rsquo; property, and stealing nontrivial value items, respectively. From a total of conduct disorder, 25 (28.1%) often lie to obtain goods, and 30 (39.5%) often truancy from school (see Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e below).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComponents of conduct disorder among governmental secondary school students at Dessie City Northeast Ethiopia, June 2024. (n\u0026thinsp;=\u0026thinsp;570).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConduct disorder\u003c/p\u003e\u003cp\u003eYes No\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBroken into someone house, car\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(100.0%) 0(0.00%)\u003c/p\u003e\u003cp\u003e40(7.0%) 528(93.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOften initiates physical fights\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34(36.6%) 59(63.4%)\u003c/p\u003e\u003cp\u003e8(1.7%) 469(98.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas forced into sexual activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(27.3%) 16(72.7%)\u003c/p\u003e\u003cp\u003e36(6.6%) 512(93.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOften bullies, threaten or intermediates other\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(65.2%) 8(34.8%)\u003c/p\u003e\u003cp\u003e27(4.9%) 520(95.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas physically cruel to animals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13(40.6%) 19(59.4%)\u003c/p\u003e\u003cp\u003e29(5.4%) 509(94.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas stolen while confronting a victims\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(80.0%) 1(20.0%)\u003c/p\u003e\u003cp\u003e38(6.7%) 527(93.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas physically cruel to people\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(39.1%) 39(60.9%)\u003c/p\u003e\u003cp\u003e17(3.4%) 489(96.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas deliberately engaged in fire settings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(63.6%) 4(36.4%)\u003c/p\u003e\u003cp\u003e35(6.3%) 524(93.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas deliberately destroyed other property\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21(37.5%) 35(52.5%)\u003c/p\u003e\u003cp\u003e21(4.1) 493(95.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas stolen items that nontrivial value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26(36.1%) 46(63.9%)\u003c/p\u003e\u003cp\u003e16(3.2%) 482(96.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOften lies to obtain goods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(28.1%) 64(71.9%)\u003c/p\u003e\u003cp\u003e17(3.5%) 464(96.5%)(\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOften stays out at night despite parental prohibited beginning before age 13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(35.2%) 35(64.8%)\u003c/p\u003e\u003cp\u003e23(4.5%) 493(95.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOften truants from school before age 13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(39.5%) 46(60.5%)\u003c/p\u003e\u003cp\u003e12(2.4%) 482(97.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas run away from home overnight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(38.5%) 8(61.5%)\u003c/p\u003e\u003cp\u003e37(6.6%) 520(93.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas used weapon that cause serious physical harm to others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(75.0%) 2(25.0%)\u003c/p\u003e\u003cp\u003e36(6.4%) 526(93.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with conduct disorder\u003c/h2\u003e\u003cp\u003eThe bivariate analysis showed that various socio-demographic, substance, and psychosocial-related factors were found to be associated with conduct disorder. Age, sex, grade level, maternal educational status, students current living status, permissive parenting style, current substance use, problematic substance use, adverse childhood experience, perceived stress level, and poor social support were significantly associated with conduct disorder.\u003c/p\u003e\u003cp\u003eHowever, multivariable logistic regression showed that six variables were positively associated with conduct disorder. Being male (AOR\u0026thinsp;=\u0026thinsp;2.519, 95% CI: 1.045\u0026ndash;6.071, p\u0026thinsp;=\u0026thinsp;0.040), unable to read and write maternal educational status (AOR\u0026thinsp;=\u0026thinsp;4.333, 95% CI: 1.199\u0026ndash;15.633, p\u0026thinsp;=\u0026thinsp;0.025), high permissive parenting style (AOR\u0026thinsp;=\u0026thinsp;3.537, 95% CI: 1.489\u0026ndash;8.401, p\u0026thinsp;=\u0026thinsp;0.004), high adverse childhood abuse (AOR\u0026thinsp;=\u0026thinsp;2.721, 95% CI: 1.019\u0026ndash;7.266, p\u0026thinsp;=\u0026thinsp;0.046), problematic substance use (AOR\u0026thinsp;=\u0026thinsp;3.004, 95% CI: 1.306\u0026ndash;6.910, p\u0026thinsp;=\u0026thinsp;0.010), and age group of 16\u0026ndash;18 years old (AOR\u0026thinsp;=\u0026thinsp;4.073, 95% CI: 1.298\u0026ndash;12.779, p\u0026thinsp;=\u0026thinsp;0.016) were significantly associated with conduct disorder in governmental secondary school students.\u003c/p\u003e\u003cp\u003eBeing male, they were more than 2.5 times more likely to have conduct disorder than females (AOR\u0026thinsp;=\u0026thinsp;2.519, 95% CI: 1.045\u0026ndash;6.071, p\u0026thinsp;=\u0026thinsp;0.040). Unable to read and write, maternal educational status was more than 4.3 times more likely to have conduct disorder than having college and above levels of educational status (AOR\u0026thinsp;=\u0026thinsp;4.333, 95% CI: 1.199\u0026ndash;15.633, p\u0026thinsp;=\u0026thinsp;0.025). Also, respondents whose age group was 16\u0026ndash;18 were 4.1 times more likely to have conduct disorder than those whose age was less than 16 (AOR\u0026thinsp;=\u0026thinsp;4.073, 95% CI: 1.298\u0026ndash;12.779, p\u0026thinsp;=\u0026thinsp;0.016). Students with a high permissive parenting style were 3.5 times more likely to develop conduct disorder than those students with a low permissive parenting style (AOR\u0026thinsp;=\u0026thinsp;3.537, 95% CI: 1.489\u0026ndash;8.401, p\u0026thinsp;=\u0026thinsp;0.004). Students with problematic substance use were 3.0 times more likely to develop conduct disorder than those students with no problematic substance use (AOR\u0026thinsp;=\u0026thinsp;3.004, 95% CI: 1.306\u0026ndash;6.910, p\u0026thinsp;=\u0026thinsp;0.010). Students with a high level of adverse childhood abuse were more than 2.7 times more likely to develop conduct disorder than those with a low level of adverse childhood abuse (AOR\u0026thinsp;=\u0026thinsp;2.721, 95% CI: 1.019\u0026ndash;7.266, p\u0026thinsp;=\u0026thinsp;0.046) (see Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e below).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBivariate and multivariate logistic regression analysis of factors associated with the conduct disorders among governmental secondary school students at Dessie City northeast Ethiopia, June 2024(n\u0026thinsp;=\u0026thinsp;570).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eConduct disorder\u003c/p\u003e\u003cp\u003eYes No\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u0026ndash;15\u003c/p\u003e\u003cp\u003e16\u0026ndash;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(50%)\u003c/p\u003e\u003cp\u003e35(8.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e133(95.0%)\u003c/p\u003e\u003cp\u003e395(91.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e1.684(0.730\u0026ndash;3.880)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.073(1.298\u0026ndash;12.779)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.016*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31(8.3%)\u003c/p\u003e\u003cp\u003e11(5.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e342(91.7%)\u003c/p\u003e\u003cp\u003e186(94.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.533(0.753\u0026ndash;3.120)\u003c/p\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.519(1.045\u0026ndash;6.071)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.040*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27(6.1%)\u003c/p\u003e\u003cp\u003e15(11.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e413(93.9%)\u003c/p\u003e\u003cp\u003e115(88.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e1.995(1.027\u0026ndash;3.876)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e1.910(.816\u0026thinsp;\u0026minus;\u0026thinsp;4.740)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.136\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade levels\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 9\u003c/p\u003e\u003cp\u003eGrade 10\u003c/p\u003e\u003cp\u003eGrade 11\u003c/p\u003e\u003cp\u003eGrade 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(6.2%)\u003c/p\u003e\u003cp\u003e6(5.3%)\u003c/p\u003e\u003cp\u003e12(6.6%)\u003c/p\u003e\u003cp\u003e17(10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e106(93.8%)\u003c/p\u003e\u003cp\u003e108(94.7%)\u003c/p\u003e\u003cp\u003e169(93.4%)\u003c/p\u003e\u003cp\u003e145(89.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e3.765(1.010-14.038)\u003c/p\u003e\u003cp\u003e3.967(1.131\u0026ndash;13.920)\u003c/p\u003e\u003cp\u003e3.945(1.098\u0026ndash;14.177)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2.099(0.435\u0026ndash;10.139)\u003c/p\u003e\u003cp\u003e1.728(0.432\u0026ndash;6.910)\u003c/p\u003e\u003cp\u003e2.457(0.672\u0026ndash;8.989)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.356\u003c/p\u003e\u003cp\u003e0.439\u003c/p\u003e\u003cp\u003e0.174\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eStrong\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(10.8%)\u003c/p\u003e\u003cp\u003e11(9.7%)\u003c/p\u003e\u003cp\u003e13(4.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e148(89.2%)\u003c/p\u003e\u003cp\u003e102(90.3%)\u003c/p\u003e\u003cp\u003e278(95.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.505 (1.154\u0026ndash;5.434)\u003c/p\u003e\u003cp\u003e3.180 (1.423\u0026ndash;7.103)\u003c/p\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.937(0.800-4.691)\u003c/p\u003e\u003cp\u003e2.289(0.860\u0026ndash;6.093)\u003c/p\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.143\u003c/p\u003e\u003cp\u003e0.098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived stress level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eModerate \u0026ndash;high\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32(6.2%)\u003c/p\u003e\u003cp\u003e12(13.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e453(93.8%)\u003c/p\u003e\u003cp\u003e75(86.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2.416 (1.185\u0026ndash;4.927)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e1.409(0.540\u0026ndash;3.678)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.484\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdverse childhood abuse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(5.4%)\u003c/p\u003e\u003cp\u003e11(13.4%)\u003c/p\u003e\u003cp\u003e8(12.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e403(94.6%)\u003c/p\u003e\u003cp\u003e71 (86.6%)\u003c/p\u003e\u003cp\u003e54 (87.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2.715 (1.268\u0026ndash;5.813)\u003c/p\u003e\u003cp\u003e2.596 (1.106\u0026ndash;6.092)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2.464(0.933\u0026ndash;6.093)\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.721(1.019\u0026ndash;7.266)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.046*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent living status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith Parents\u003c/p\u003e\u003cp\u003eWith spouse\u003c/p\u003e\u003cp\u003eWith friends\u003c/p\u003e\u003cp\u003eLonely\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (7.0%)\u003c/p\u003e\u003cp\u003e2(3.9%)\u003c/p\u003e\u003cp\u003e6(7.1%)\u003c/p\u003e\u003cp\u003e13(11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e334(93.9%)\u003c/p\u003e\u003cp\u003e49(96.1%)\u003c/p\u003e\u003cp\u003e65(92.9)\u003c/p\u003e\u003cp\u003e80(88.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e0.5450.125\u0026ndash;2.374)\u003c/p\u003e\u003cp\u003e1.028(0.379\u0026ndash;2.783)\u003c/p\u003e\u003cp\u003e1.670(0.771\u0026ndash;3.617)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e0.572(0.095\u0026ndash;3.453)\u003c/p\u003e\u003cp\u003e1.090(0.290\u0026ndash;4.092)\u003c/p\u003e\u003cp\u003e1.441(0.536\u0026ndash;3.873)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.543\u003c/p\u003e\u003cp\u003e0.898\u003c/p\u003e\u003cp\u003e0.469\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMother Educational status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnable to read \u0026amp; write\u003c/p\u003e\u003cp\u003eAble to read \u0026amp; write\u003c/p\u003e\u003cp\u003eGrade 1\u0026ndash;8\u003c/p\u003e\u003cp\u003eGrade 9\u0026ndash;12\u003c/p\u003e\u003cp\u003eCollege \u0026amp; above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(11.9%)\u003c/p\u003e\u003cp\u003e14(9.1%)\u003c/p\u003e\u003cp\u003e2(5.7%)\u003c/p\u003e\u003cp\u003e4(2.2%)\u003c/p\u003e\u003cp\u003e4(2.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e133(88.1%)\u003c/p\u003e\u003cp\u003e140(90.9%)\u003c/p\u003e\u003cp\u003e33(94.3%)\u003c/p\u003e\u003cp\u003e40(90.9%)\u003c/p\u003e\u003cp\u003e182(97.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.158(2.037\u0026ndash;18.615)\u003c/p\u003e\u003cp\u003e4.550(1.466\u0026ndash;14.125)\u003c/p\u003e\u003cp\u003e2.758(0.485\u0026ndash;15.670)\u003c/p\u003e\u003cp\u003e4.550(1.092\u0026ndash;18.966)\u003c/p\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e4.333(1.199\u0026ndash;15.653)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e3.190(0.923\u0026ndash;11.030)\u003c/p\u003e\u003cp\u003e2.181(0.330-14.397)\u003c/p\u003e\u003cp\u003e2.000(0.378\u0026ndash;10.589)\u003c/p\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.025*\u003c/b\u003e\u003c/p\u003e\u003cp\u003e0.067\u003c/p\u003e\u003cp\u003e0.418\u003c/p\u003e\u003cp\u003e0.415\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent substance use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(6.5%)\u003c/p\u003e\u003cp\u003e23(10.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e414(93.5%)\u003c/p\u003e\u003cp\u003e114(89.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e0.614(0.309\u0026ndash;1.220)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e0.612(0.241\u0026ndash;1.554)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.301\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePermissive parenting style\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(5.8%)\u003c/p\u003e\u003cp\u003e17(12.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e406(94.2%)\u003c/p\u003e\u003cp\u003e122(87.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2.263(1.183\u0026ndash;4.328)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.537(1.489\u0026ndash;8.401)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProblematic substance use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(3.6%)\u003c/p\u003e\u003cp\u003e8(10.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e478(96.4%)\u003c/p\u003e\u003cp\u003e66(89.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e3.219(1.565\u0026ndash;6.743)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.004(1.306\u0026ndash;6.910)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.010*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eKey: * = p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSIONS","content":"\u003cp\u003eThis study indicated that the magnitude of conduct disorder was 7.4% among government secondary school students in Dessie City, Ethiopia. This study finding is consistent with the study conducted in the USA [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], Japan [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], and Ethiopia (among primary school students) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, conduct disorder in this study is lower than the study done in the United Kingdom (16%) [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] and in Nigeria (9.8%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], 14.5% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This could be due to the sample size, socio-cultural differences, and differences in study design. Cohort study design was used in the United Kingdom, and the Vanderbilt Attention-Deficit Hyperactivity Disorder Diagnostic Teacher Rating Scale was used to assess conduct disorder, and a large sample size was used in Nigeria (1174), whereas our study utilized disruptive behavioral disorder tools to assess conduct disorder and a cross-sectional study design.\u003c/p\u003e\u003cp\u003eIn addition, it was also lower than the study conducted in Kenya (31.4%) [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] and China (58.72%) [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This discrepancy could probably be due to the sampling techniques, the purposive sampling technique used in Kenya, and the study populations difference focused on correctional facilities and juvenile homes, environments that can significantly impact behaviors and attitudes in China, which could increase the conduct disorder rates.\u003c/p\u003e\u003cp\u003eThe current study finding is slightly higher than studies done in India (5.48%) [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], (4.58%) [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], (3.0%) [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], and in Uganda (2%) [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. The difference could be due to their difference in age of students included in the study, socio-culture, screening tools, and sample size difference.\u003c/p\u003e\u003cp\u003eConduct disorders were associated with being a male, an age group of 16-18-year-olds, a high level of adverse childhood abuse, problematic substance use, maternal educational status (unable to read and write), and a high permissive parenting style.\u003c/p\u003e\u003cp\u003eThe odds of developing conduct disorder are higher among male students as compared to female students. This is in line with studies conducted in Nigeria [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] and Kenya [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Behaviors such as unapproved absences from school, fighting, possession of dangerous weapons, vandalism of school property, bullying, theft, reckless driving, cheating, selling stolen goods, throwing objects at others, jumping school fences, and involvement in school riots are common among male students [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Conversely, the patterns of conduct disorder among female students are characterized by behaviors such as gossiping, engaging in sexual immorality, tearing examination reports, verbally abusing teachers and parents, and watching pornographic content.\u003c/p\u003e\u003cp\u003eStudents in the age group 16\u0026ndash;18 years old were more likely to develop conduct disorder than students with lower ages (14\u0026ndash;15). This finding is in line with the study done in Kenya [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and Ethiopia [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This could be related to the fact that as adolescents mature, they become involved in violent groups and substance abuse, getting more freedom, which enables them to engage in more severe conduct issues, such as theft or assault. This indicates that the maturity level of students plays a significant role in their behavior. Such patterns may be linked to the biological and social changes that occur during a child's development [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. In addition, environmental factors may play a role; experiencing civil war in the study area and witnessing bad behaviors from militants and being influenced by peer relationships may lead to various behavioral problems, including smoking, fighting, and involvement in gangs. Furthermore, increased freedom to leave the home exposes them to potentially harmful relationships [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study showed that the magnitude of conduct disorder among secondary school students was higher among students whose maternal education is illiterate (unable to read and write). This finding is consistent with the study conducted in Tehran city [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Mothers often have more interaction with children to address educational, behavioral, and emotional issues. Consequently, it is reasonable to conclude that maternal educational status negatively influences the quality of child-rearing.\u003c/p\u003e\u003cp\u003eHigh permissive parenting styles were riskier to develop conduct disorder in their children than low permissive parenting styles. This finding is consistent with the study conducted in Nigeria [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] and Ethiopia [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Parents play a crucial role in shaping their children's mental, emotional, and behavioral development, preparing them for adulthood. Once children begin school, parents are typically responsible for overseeing their conduct, education, and homework. They also collaborate with school authorities to address any educational, behavioral, or emotional challenges. Consequently, it is evident that a family's parenting style directly influences the overall quality of child-rearing. In addition, children raised in a negligent-permissive parenting style often exhibit immaturity, poor impulse control, and a lack of responsibility. As they enter adolescence, these tendencies can lead to increased impulsivity and behaviors such as drug use [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, students with a high level of adverse childhood experiences were more likely to develop conduct disorder. This finding is consistent with a study done in Slovakia [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e] and China [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Experiencing traumatic events during childhood can lead to significant distress, which is often linked to emotional and behavioral problems. This distress may result in lasting changes in the nervous system. Furthermore, it's likely that these adverse childhood experiences (ACEs) persist into adolescence, continuing to exert a direct and immediate impact on individuals [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. In addition, exposure to high levels of conflict or violence between caregivers can normalize aggressive behaviors and disrupt emotional development, and unpredictable responses from caregivers can lead to confusion and frustration and increase the likelihood of conduct issues [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStudents with problematic substance use were more likely to have conduct disorder. This finding is in line with a study conducted in the USA [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. This could be due to substances that can alter brain chemistry, which is responsible for decision-making and impulse control, so early-onset substance use poses serious challenges for both individuals and society for students, like impulsivity, irritability, and potentially resulting in violent behaviors.\u003c/p\u003e\u003cp\u003eDespite this study showing the magnitude of conduct disorder and its associated factors among secondary school students, it has limitations. Students and their parents might forget the childhood experiences and might not respond to some socially sensitive situations, like substance and sexual-related questions. In addition, this study was limited to school adolescents and youths; it might miss those adolescents and youths with conduct disorder in the community. As a result, these could minimize the magnitude of conduct disorder.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThe magnitude of conduct disorder among secondary school students in Dessie City, Ethiopia, was comparable with the global estimated prevalence rate. Being male, in the age category (16-18-year-old), problematic substance use, adverse childhood abuse, students\u0026rsquo; maternal educational status, and permissive parenting style were significantly associated with conduct disorder. Therefore, increasing parental knowledge and strengthening parental skills, advocating for mother education, and preventing childhood abuse and substance use among students could help to reduce students\u0026rsquo; conduct behaviors. Alongside strengthening school student counseling and help-seeking attitude, contribute to resilience and control impulses.\u003c/p\u003e"},{"header":"LIST OF ABBREVIATIONS","content":"\u003cp\u003eAOR Adjusted Odds Ratio\u003c/p\u003e\u003cp\u003eCD Conduct Disorder\u003c/p\u003e\u003cp\u003eCAGE Cut Down, Annoyed, Guilty Feeling, Eye opener\u003c/p\u003e\u003cp\u003eCI Confidence Interval\u003c/p\u003e\u003cp\u003eCOR Crude Odds Ratio\u003c/p\u003e\u003cp\u003eDBD Disruptive Behavioral Disorder\u003c/p\u003e\u003cp\u003e IERC Institutional Ethical Review Committee\u003c/p\u003e\u003cp\u003ePSS Parenting Style Scale\u003c/p\u003e\u003cp\u003eSPSS Statistical Package for Social Science\u003c/p\u003e\u003cp\u003eOSLO-3 Oslo Social Support scale-3\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eAll methods were carried out in accordance with relevant guidelines and regulations. Ethical approval was approved by Wollo University, Institutional Ethical Review Committee (IERC) of College of Medicine and Health sciences, Wollo Tertiary Care and Teaching Hospital, Tertiary Care campus. Ethical approval letter was given for all selected school directors and permission was obtained from Dessie City administration education bureau and selected schools before data collection. Written informed consent was obtained from each selected grade and section representative teachers and students’ parent before data collections. Ensuring they understand the study's purpose, procedures, and confidentiality measures. Data confidentiality and anonymity were maintained throughout the study, with strict data security measures in place. The study strictly follows ethical guidelines from Wollo University, prioritizing participant safety and privacy. Study participants having three yes answers and above from conduct disorder measurement tools adapted from DBD were referred to Dessie Comprehensive Specialized Hospital, the nearby hospital, for further evaluation and managements of their behaviors.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eOur manuscript doesn’t contain any individual person’s data in any form (including individual details, images or videos). So, the consent for publication is “\u003cb\u003eNot applicable\u003c/b\u003e” in this section.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEM, MS and JS designed and supervised the study, carried out the analysis, and interpreted the data; BF, ZB, SY, TA, MSH, AB, BY, HG, YZ and TA assisted in the design, analysis, and interpretation of the data; and MS wrote the manuscript. All authors contributed toward data analysis, drafting, and critically revising the paper and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank Wollo University College of Medicine and Health Sciences and Dessie City Educational Office for their cooperation and assistance throughout the study process.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data analyzed during this study are included in this manuscript article. The data sets used and analyzed during the current study are available from the corresponding author [Muhammed Seid, Email: [email protected];Mobile: +2519–13163924, Wollo University, Dessie, Ethiopia], on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVahia, V. N. 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Parental attachment, physical abuse and conduct disorder among secondary school adolescents in Ondo State, Nigeria. \u003cem\u003eJ. Psychiatry\u003c/em\u003e. \u003cb\u003e24\u003c/b\u003e, p466 (2021).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrohn, M. D., Larroulet, P., Thornberry, T. P. \u0026amp; Loughran, T. A. The effect of childhood conduct problems on early onset substance use: An examination of the mediating and moderating roles of parenting styles. \u003cem\u003eJ. Drug Issues\u003c/em\u003e. \u003cb\u003e49\u003c/b\u003e (1), 139\u0026ndash;162 (2019).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Conduct Disorder, Dessie City, Ethiopia, Secondary School Students","lastPublishedDoi":"10.21203/rs.3.rs-6409604/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6409604/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e\u003cp\u003eConduct disorder is a behavioral and mental health disorder that typically develops in childhood or adolescence and is characterized by a persistent pattern of violating the rights of others or social norms. It is linked with aggression towards people or animals, destruction of property, deceitfulness, or theft but little is known about conduct disorder among government secondary school students in Dessie City, Ethiopia. This study aimed to assess the magnitude of conduct disorder and its associated factors among secondary school students in Dessie City, Northeast Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eAn institution-based cross-sectional study design was conducted from June 1\u0026ndash;30/ 2024. A multistage stratified sampling technique was used to select 570 government secondary school students. Data were collected using a self-administered questionnaire. A Disruptive Behavior Disorder (DBD) rating scale was used to measure conduct disorder among students. The collected data were coded and entered into Epi-data version 4.6 and then exported to SPSS version 26 for further analysis. Bivariable and multivariable logistic regressions with odds ratios (ORs) and 95% confidence interval (CIs) at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were employed as the result.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe magnitude of conduct disorder among government secondary school students was 7.4% (95% CI: 5.3, 9.6). Approximately 87(15.3%) participants experienced moderate to high-stress levels, and 62(10.9%) experienced high levels of adverse childhood abuse. In multivariable logistic regression analyses, the associated factors for conduct disorder were being male (AOR\u0026thinsp;=\u0026thinsp;2.519, 95% CI: 1.045\u0026ndash;6.071), age category (16\u0026ndash;18) (AOR\u0026thinsp;=\u0026thinsp;4.07 95% CI:1.29\u0026ndash;12.77), problematic substance use (AOR\u0026thinsp;=\u0026thinsp;3.00, 95% CI: 1.31\u0026ndash;6.91), adverse childhood abuse (AOR\u0026thinsp;=\u0026thinsp;2.72 95CI: 1.02\u0026ndash;7.26), maternal educational status (AOR\u0026thinsp;=\u0026thinsp;4.33, 95% CI: 1.19\u0026ndash;15.63) and permissive parenting style (AOR\u0026thinsp;=\u0026thinsp;3.53, 95% CI:1.48\u0026ndash;8.40).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe magnitude of conduct disorders among secondary school students in Dessie City was comparable to the estimated global prevalence rate. Being male, age category, problematic substance use, adverse childhood abuse, maternal educational status, and permissive parenting style were significantly associated with conduct disorders. Therefore, increasing parental knowledge and strengthening parental skills, advocating for mothers' education, and preventing substance use among students could help reduce youth\u0026rsquo;s conduct problems.\u003c/p\u003e","manuscriptTitle":"Conduct Disorder and Its Associated Factors Among Governmental Secondary School Students in Dessie City, Northeast Ethiopia, a Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-12 01:15:19","doi":"10.21203/rs.3.rs-6409604/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-05T12:15:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-10T09:20:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87119015808351247202674997482883665888","date":"2025-10-27T05:29:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206195845402943681456474359564017227559","date":"2025-10-26T14:25:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136039302428918956279792097255901067106","date":"2025-09-30T15:55:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T15:30:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68676842148862023259841493718064462982","date":"2025-08-18T14:35:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-06T12:18:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-25T06:34:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-22T20:53:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-22T05:04:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-04-09T08:12:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c4cd4df2-f595-4ed3-9cc1-bb128f51cab3","owner":[],"postedDate":"August 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":52986642,"name":"Biological sciences/Psychology"},{"id":52986643,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-12-23T10:53:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-12 01:15:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6409604","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6409604","identity":"rs-6409604","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}