Correlates of cannabis use among high school students in Shamva District, Zimbabwe: A descriptive cross-sectional study

Substance use among young people in sub-Saharan Africa: a systematic review and meta-analysis

Background

The use of substances such as alcohol, tobacco, khat, or drugs among young people is becoming a public health concern globally, with particularly high prevalence rates in low and middle-income settings, where socio-cultural and economic factors contribute to distinct challenges in addressing this problem. This review aimed to summarize the current literature on the prevalence of substance use among young people in sub-Saharan Africa (SSA) and identify gaps in the current body of literature.

Methods

Seven databases and Google were searched for studies reporting on substance use prevalence among young people (aged 10-24 years) in SSA, published between January 2010 and May 2024. Observational studies were included, assessed for methodological quality, and checked for the presence of heterogeneity and publication bias using standard methods. A random effect model was used to estimate the pooled proportions for substance use among young people.

Results

The literature search identified 1,889 hits from the databases and Google. Among these 60 eligible studies involving 83,859 respondents were included in the review. The overall lifetime, 12-month, and current prevalence of any substance use among young people in SSA was found to be 21.0% (95% CI= 18.0, 24.0), 18% (95% CI=10,27), and 15% (95% CI=12,18), respectively. Among young people from SSA, alcohol use problem was the most prevalent (40%), followed by khat use (25%), stimulant use (20%), and cigarette smoking (16%). Other substances used by a smaller proportion of young people included cannabis, cocaine, inhalants, sedatives, shisha, hallucinogens, steroids, and mastics. The prevalence of substance use problems was higher among males compared to females, highest in the southern African region followed by Western and Eastern regions, and in community-based studies compared to institutional-based studies.

Conclusions

In SSA, over a fourth of young people use at least one substance in their lifetime, with higher rates among males than females and in community-based compared to institution-based studies. These results emphasize the need for interventions targeting the wider young population and those in specific subgroups identified as being at higher risk of substance use. This approach allows for the provision of tailored support and resources to those who need it most while also promoting positive health outcomes for the entire population of young people in the region.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022366774, identifier CRD42022366774.

Prevalence, correlates, and reasons for substance use among adolescents aged 10-17 in Ghana: a cross-sectional convergent parallel mixed-method study

BACKGROUND

Substance use among adolescents poses significant risks to their health, wellbeing, and development, particularly in low- and middle-income countries, including Ghana. However, little is known about the outlets and reasons for substance use among Ghanaian adolescents. This study examined the prevalence, correlates, reasons for substance use, and outlets of these substances among adolescents aged 10-17 in Ghana.

METHODS

Data were obtained from the Department of Children, Ministry of Gender, Children, and Social Protection, Ghana, which employed a cross-sectional convergent parallel mixed-methods technique to collect quantitative and qualitative data from children aged 8-17, parents or legal guardians and officials of state institutions responsible for the promotion and protection of children's rights and wellbeing. Overall, 4144 adolescents aged 10-17 were interviewed for the quantitative data, while 92 adolescents participated in 10 focus group discussions. Descriptive statistics, Pearson's chi-square test, and multivariable binary logistic regression were used to analyse the quantitative data, while the qualitative data was analysed thematically.

RESULTS

The prevalence of substance use was 12.3%. Regarding the types of substance use, alcohol (56.9%) and cigarettes (26.4%) were the most common substances. Being a male and currently working are significant risk factors, whereas being aged 10-13, and residing in the Middle- and Northern-ecological belts of Ghana are significant protective factors of substance use. Peers, household members who use substances, drug stores, and drug peddlers are the major outlets. The reasons for substance use were fun, substance as an aphrodisiac, boosting self-confidence, dealing with anxiety, and improved social status.

CONCLUSIONS

There is a relatively high substance use among adolescents in Ghana, and this calls for a multi-sectoral approach to addressing substance use by providing risk-behaviour counselling, parental control, and effective implementation of substance use laws and regulations.

Cannabis use in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND AND AIMS

The most available data on the prevalence of cannabis use come from population surveys conducted in high-income countries in North America, Oceania and Europe. Less is known about the prevalence of cannabis use in Africa. This systematic review aimed to summarize general population-level cannabis use in sub-Saharan Africa since 2010.

METHODS

A comprehensive search was conducted in PubMed, EMBASE, PsycINFO and AJOL databases in addition to Global Health Data Exchange and grey literature without language restriction. Search terms related to 'substance', 'Substance-Related Disorders' and 'Prevalence' and 'Africa South of the Sahara' were used. Studies that reported cannabis use in the general population were selected, while studies from clinical populations and high-risk groups were excluded. Prevalence data on cannabis use in the general population of adolescents (10-17 years) and adults (≥ 18 years) in sub-Saharan Africa were extracted.

RESULTS

The study included 53 studies for the quantitative meta-analysis and included 13 239 participants. Among adolescents, the life-time, 12-month and 6-month prevalence of cannabis use were 7.9% [95% confidence interval (CI) = 5.4-10.9%], 5.2% (95% CI = 1.7-10.3%) and 4.5% (95% CI = 3.3-5.8%), respectively. The corresponding life-time, 12-month and 6-month prevalence of cannabis use among adults were 12.6% (95% CI = 6.1-21.2%), 2.2% (95% CI = 1.7-2.7%, with data only available from Tanzania and Uganda) and 4.7% (95% CI = 3.3-6.4%), respectively. The male-to-female life-time cannabis use relative risk was 1.90 (95% CI = 1.25-2.98) among adolescents and 1.67 (CI = 0.63-4.39) among adults.

CONCLUSIONS

Life-time cannabis use prevalence in sub-Saharan Africa appears to be approximately 12% for adults and just under 8% for adolescents.

Perceptions and prevalence of marijuana use among cancer patients managed at an outpatient department in Zimbabwe: A brief report

BACKGROUND

Globally, marijuana is becoming an acceptable complementary medicine for symptom management in cancer. At the time that the study was conducted, Zimbabwean laws only allowed for the cultivation of marijuana for medical and scientific use. As of 18 July 2022, the national medicines regulator released a circular allowing the licensing, distribution, and use of cannabidiol-based products. Anecdotes indicate there is medical marijuana use among Zimbabwean patients with cancer. We sought to determine the prevalence, patterns of use and perceptions of medical marijuana among patients with cancer.

METHODS

A cross-sectional survey was used to determine patterns and perceptions of marijuana use among outpatient patients with cancer. The study included adults attending the outpatient oncology clinic at Parirenyatwa Hospital Radiotherapy Treatment Center.

RESULTS

Fifty participants with a median age of 50.5 years (IQR: 41-58) completed the questionnaire, and 28.0% of them were male. The prevalence of marijuana use in the sample was 24.0% (95% CI 13.9-38.2). Most marijuana users were male (83.3%, p < 0.001). The rate of medical marijuana use among users was 66.7%. Participants were generally neutral concerning the benefits of marijuana and how it should be regulated. Just under 50% indicated that they would be open to using it if it were legal.

CONCLUSIONS AND RECOMMENDATIONS

The prevalence of marijuana use in the sample was comparable to other jurisdictions. Perceptions toward medical marijuana were generally neutral. Consequently, for medical marijuana and/or cannabidiol-based products to become acceptable in the Zimbabwean context, there is need for the dissemination of evidence-based information on their benefits.

Prevalence, associated factors and level of dependence of substance use among urban secondary school students, Benin

The use of psychoactive substances is constantly increasing, particularly among young people. This study aimed to estimate the prevalence, associated factors and the level of dependence of those substances among secondary school students in Benin. This cross-sectional study included 627 students in grades 8-12, selected using a multi-stage sampling technique. Data were collected using the ASSIST questionnaire, followed by urine screening. Logistic regression analysis was performed to estimate factors associated with substance use. Overall, the lifetime prevalence of psychoactive substance use was 95.4% (95% CI = 93.4-96.9), while the current use was 78.8% (95% CI = 75.3-81.9). The most commonly used substances in the past 3 months were alcohol, followed by stimulants and tobacco; 221 samples were analysed. Twenty-two (9.95%) were positive by urine screening. Substances detected were tramadol, fentanyl, THC, K2, BZDs, alcohol, methamphetamine and cotinine. Of the current users, 2.27% (n = 11) were at high risk of dependency. An association was found between substance use and age (p = 0.02). In conclusion, this study came up with a high prevalence of substance use among students. There is a need to develop and implement a health education programme in secondary schools to raise awareness of the potential risks.

Alcohol and illicit drug use among young people living with HIV compared to their uninfected peers from the Kenyan coast: prevalence and risk indicators

BACKGROUND

In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people's HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people.

METHODS

Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18-24 years (407 HIV-positive). Alcohol and drug use disorders identification tests (AUDIT and DUDIT) were administered via audio computer-assisted self-interview alongside other measures. Logistic regression was used to determine substance use risk indicators.

RESULTS

The point prevalence of current substance use was significantly lower among YLWH than HIV-uninfected youths: current alcohol use, 13% vs. 24%, p <  0.01; current illicit drug use, 7% vs. 15%, p <  0.01; current alcohol and illicit drug use comorbidity, 4 vs. 11%, p <  0.01. Past-year prevalence estimates for hazardous substance use were generally low among young people in this setting (< 10%) with no significant group differences observed. Being HIV-positive independently predicted lower odds of current substance use, but not hazardous substance use. There was overlap of some risk indicators for current substance use between young people with and without HIV including male sex, khat use and an experience of multiple negative life events, but risk indicators unique to either group were also identified. Among YLWH, none of the HIV-related factors was significantly associated with current substance use.

CONCLUSIONS

At the Kenyan coast, substance use is a reality among young people. The frequency of use generally appears to be low among YLWH compared to the HIV-uninfected peers. Substance use prevention initiatives targeting young people, regardless of HIV infection status, are warranted in this setting to avert their potential risk for developing substance use disorders, including dependence. The multifaceted intrapersonal and interpersonal factors that place young people at risk of substance use need to be addressed as part of the substance use awareness and prevention initiatives.

The Risky Health Behaviours of Male Adolescents in the Southern Italian Region: Implications for Sexual and Reproductive Disease

Recent epidemiological studies suggest an increase of sexual and reproductive chronic diseases caused by problematic behaviours acquired during peri-pubertal age. The aims of our study were: (i) to investigate awareness of sexual transmitted infections (STIs) among adolescents; (ii) to describe the close relationship between possibly incorrect lifestyles during adolescence and reproductive and sexual disturbances during adulthood. The “Amico-Andrologo” survey is a permanent nationwide surveillance program supported by the Italian Ministry of Health. We administered a validated structured interview to investigate the lifestyle of adolescents and their knowledge of STIs. We selected a cohort of 360 male high-school students aged ≥18 years old. In this cohort, 150 (41.5%) were smokers while 59 (19.7%) smoked more than 10 cigarettes/day; 25 (9.3%) declared a consumption ≥6 drinks/weekend; and 65 (19.7%) were habitual cannabis consumers (at least twice/week). Among the sample of students selected, the main sources of sexual disease information were the internet and friends. The perceived level of knowledge on STIs was the same between students that used contraceptive methods and students that did not. The present results demonstrate that adolescents in Calabria do not receive appropriate information about risky health behaviours. Therefore, there is a necessity for specific educational programs to increase awareness of dangerous behaviours during the transitional age that is relevant for a safe sexual and reproductive adult life.

Cannabis and amphetamine use and socio-ecological (proximal and distal) factors among school-going adolescents in four countries in the Caribbean and four countries in South America

The study aimed to assess the prevalence of cannabis and amphetamine use and socio-ecological (proximal and distal) factors among adolescents in eight countries of the Americas. We analysed cross-sectional survey data from 44,904 adolescents [mean age 14.6 years, standard deviation (SD) = 1.4] from Argentina, The Bahamas, Barbados, Belize, Bolivia, Chile, Peru and Trinidad and Tobago that participated in the Global School-Based Student Health Survey (GSHS) in 2011-2013. The prevalence of the past month's cannabis use was 8.3% and lifetime amphetamine use was 3.0%. In adjusted mixed-effects logistic regression analysis older age, male gender, personal attributes (anxiety, suicidal ideation, current tobacco use, current alcohol use, school truancy and sexual risk behaviour) and environmental stressors (having been in a physical fight, hunger, being bullied) were positively and parental support and peer support were negatively associated with the past month's cannabis and/or lifetime amphetamine use. Measures to prevent and control cannabis and amphetamine use in this adolescent population should include personal attributes (mental health, substance use, school truancy and sexual risk behaviour), environmental stressors and parental and peer support.

Prevalence and predictors of alcohol and drug use among secondary school students in Botswana: a cross-sectional study

BACKGROUND

Alcohol and illicit drug use has been recognized as a growing problem among adolescents in Botswana. Little is known about factors affecting alcohol and drug use among Botswana's secondary school students. To aid the design and implementation of effective public health interventions, we sought to determine the prevalence of alcohol and drug use in secondary school students in urban and peri-urban areas of Botswana, and to evaluate risk and protective factors for substance use.

METHODS

We performed a 72-item cross-sectional survey of students in 17 public secondary schools in Gaborone, Lobatse, Molepolole and Mochudi, Botswana. The World Health Organization's (WHO) Alcohol Use Disorder Identification Test (AUDIT) was used to define hazardous drinking behavior. Using Jessor's Problem Behavior Theory (PBT) as our conceptual framework, we culturally-adapted items from previously validated tools to measure risk and protective factors for alcohol and drug use. Between-group differences of risk and protective factors were compared using univariate binomial and multinomial-ordinal logit analysis. Relative risks of alcohol and drug use by demographic, high risks and low protections were calculated. Multivariate ordinal-multinomial cumulative logit analysis, multivariate nominal-multinomial logit analysis, and binominal logit analysis were used to build models illustrating the relationship between risk and protective factors and student alcohol and illicit drug use. Clustered data was adjusted for in all analyses using Generalized Estimating Equations (GEE) methods.

RESULTS

Of the 1936 students surveyed, 816 (42.1%) reported alcohol use, and 434 (22.4%) met criteria for hazardous alcohol use. Illicit drug use was reported by 324 students (16.7%), with motokwane (marijuana) being the most commonly used drug. Risk factors more strongly associated with alcohol and drug use were reported alcohol availability, individual and social vulnerability factors, and poor peer modeling. Individual and social controls protections appear to mitigate risk of student alcohol and drug use.

CONCLUSIONS

Alcohol and illicit drug use is prevalent among secondary school students in Botswana. Our data suggest that interventions that reduce the availability of alcohol and drugs and that build greater support networks for adolescents may be most helpful in decreasing alcohol and drug use among secondary school students in Botswana.