Bullying, School Skipping, and Sadness Predict Substance Use in African Adolescents

Among school-going adolescents (ages 11-16) across 25 African countries, marijuana use prevalence was 3.4% (95% CI 2.7-4.2%). Unlike cigarette smoking, marijuana use did not differ significantly by sex. Parental tobacco use, being bullied, missing school without permission, and experiencing sadness and hopelessness were positively associated with being a current user regardless of substance type.

Pooled cross-sectional analysis of the Global School-based Health Survey (GSHS) from 25 African countries (2003-2017). Descriptive statistics estimated prevalence. Logistic regressions modeled factors associated with alcohol, cigarette, and marijuana use with adjusted odds ratios. Dual-use patterns were also examined.

This is one of the largest studies of adolescent substance use across the African continent, revealing that marijuana use among school-going youth is lower than alcohol (9.5%) and cigarettes (6.2%) but shares the same risk factors. The consistent role of mental health factors like bullying and sadness across all substance types suggests integrated prevention approaches could be effective.

Substance use research in Africa has historically received less attention than in North America or Europe. These findings show that while prevalence rates differ, the underlying risk factors for adolescent substance use are remarkably consistent globally, suggesting universal prevention strategies targeting bullying, school engagement, and emotional wellbeing could reduce use.

Cross-sectional design cannot establish causal direction. Self-reported substance use may underestimate true prevalence. Data span 2003-2017, so current patterns may differ. School-based survey excludes out-of-school adolescents who may have higher use rates.