Across nearly 39,000 adolescents in five Asian countries, lifetime cannabis use was under 1%, and current cigarette smoking was the only factor consistently associated with cannabis use in every country.
Readers interested in global patterns of adolescent cannabis use.
Lifetime cannabis use was only 0.9% among 38,941 Asian adolescents
What the researchers found
Among 38,941 school-aged adolescents (mean age 15.4 years) in Iraq, Kuwait, Malaysia, Mongolia, and Vietnam, overall lifetime cannabis use was 0.9% and lifetime amphetamine use was 1.0%.
Current cigarette smoking was the only variable significantly associated with cannabis use across all five countries. Male gender was associated with cannabis use in Kuwait and Mongolia. Parental smoking was associated with cannabis use in Kuwait and Iraq.
For amphetamine use, the predictors were different and more tied to mental health: suicidal ideation, school truancy, being a victim of physical assault, bullying victimization, and anxiety were significant predictors in various country combinations, with current cigarette use again significant everywhere.
Why it matters
While most cannabis research focuses on Western populations, this study provides data on adolescent use patterns in Asian countries where cannabis remains highly stigmatized and largely illegal. The consistent link between cigarette smoking and cannabis use across culturally diverse countries suggests this association is not culturally specific.
The numbers in context
38,941 adolescents surveyed. Mean age 15.4 years. Lifetime cannabis use: 0.9%. Lifetime amphetamine use: 1.0%. Current cigarette smoking was associated with cannabis use in all five countries.
How the study worked
Cross-sectional analysis using data from the Global School-Based Student Health Survey (GSHS), a WHO-supported standardized survey. Logistic regression was used to identify predictors of lifetime cannabis and amphetamine use across the five countries.
What this study cannot tell us
Cross-sectional design cannot determine whether cigarette smoking leads to cannabis use or both share common risk factors. Self-report in school settings may underestimate true prevalence, especially in countries with harsh drug penalties. School-based surveys miss out-of-school youth who may have higher substance use rates. Data are from different years across the five countries.
How to read the evidence
Moderate evidence from a large, multi-country cross-sectional survey using a standardized WHO instrument.
When this study was published
Published in 2017. Data from the Global School-Based Student Health Survey.
The bigger picture
The extremely low prevalence rates in these Asian countries contrast sharply with rates of 20-40% lifetime cannabis use reported among Western adolescents. Cultural norms, legal environments, and availability clearly play major roles in adolescent cannabis use. The universal cigarette-cannabis link reinforces the value of tobacco prevention as a potential upstream intervention.
Questions still open
- Would these prevalence rates change with shifting cultural attitudes toward cannabis in Asia? Is the cigarette-cannabis link explained by shared risk factors, pharmacological gateway effects, or social exposure? How do rates compare among out-of-school youth in these countries?
Common questions
Why is cannabis use so much lower in these Asian countries?
Does cigarette smoking cause cannabis use?
Read the original research
Cannabis and Amphetamine Use Among Adolescents in Five Asian Countries.
Central Asian journal of global health, 6(1), 288
Citation
Peltzer, Karl; Pengpid, Supa. (2017). Cannabis and Amphetamine Use Among Adolescents in Five Asian Countries.. Central Asian journal of global health, 6(1), 288. https://doi.org/10.5195/cajgh.2017.288
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