Emerging burden of alcohol, drug, and tobacco use initiations among 303,519 school-going adolescents in 92 countries

Abstract Adolescent alcohol, drug, and tobacco use is an emerging public health concern in low and middle-income countries (LMICs) and high-income countries (HICs). Yet, there is a lack of reliable, national-level data to inform policies and prevention interventions. This study aimed to provide the best available associations of global and regional risk and protective factors of the early initiation of alcohol, drugs, and tobacco use (before 14 years or 14–17 years old) amongst school–going adolescents. A total of 303,519 adolescents participated in this study. They were drawn from 92 countries in the latest Global School–based Student Health Survey of school children aged 14–17 years. Our analysis covered the period between 2003 and 2015 for which data are available, grouped according to the six World Health Organization (WHO) regions. The pooled weighted prevalence of early initiation of alcohol, drug and tobacco use amongst adolescents (aged <14 years) was 15·37% (28·19% for aged 14–17 years), 3·86% (6·78% for aged 14–17 years), and 6·21% (vs. 16·20% for aged 14–17 years), respectively. The prevalence of the initiation of drinking alcohol (42·60%) and drug use (8·30%) were also pronounced among adolescents in high-income countries, HICs compared to low-income countries, LICs (16·07% for drinking alcohol and 5·53% for drug use) and lower-middle income countries, LMICs (15·50% for drinking alcohol and 5·24% for drug use). One in five adolescents (20·53%) had started drinking alcohol before they were 14 years old in the Western Pacific and Americas Regions, followed by 11·91% in the African region and 5·11% in South–East Asian region. The prevalence of drug use was highest for the Americas region (5·66% aged <14 years and 8·14% aged between 14–17 years old) and lowest in the South–East Asia region (1·18% of adolescents aged <14 years and 4·40% of adolescents aged 14–17 years). In addition, the pooled prevalence of tobacco use (adolescents <14 years) was more than double among adolescents in HICs (21·28%) compared to adolescents in LMICs (10·10%) and in LICs (9·63%). The early initiation of alcohol, drug and tobacco use was associated with being physically attacked, physical fighting, high levels of anxiety, feeling lonely, being bullied, a lack of parental support and close friends, poor peer support and high levels of sedentary behaviour. We found similar associations across six WHO regions and country income groups (LICs–HICs). School–based prevention efforts that promote a healthy lifestyle and environmental change are urgently needed.