Over one-fifth of teenagers in India could be at moderate, high risk of substance use: Study

A study that looked at over 6,000 teenagers from across 108 schools in India has found that over a fifth might be at moderate-to-high risk of substance use.

Published in The Lancet Regional Health-Southeast Asia journal, the study was conducted in government and private schools across six districts — Gorakhpur in Uttar Pradesh, Assam’s Kamrup, Nagpur in Maharashtra, Rajkot in Gujarat), Jharkhand’s Deoghar, and Puducherry.

“Overall, 21.4% of adolescents were reported as having moderate (or) high substance use risk, including 10.3 % with moderate risk and 11.1 % with high risk. The remaining adolescents (78.6 %) were reported as low risk,” authors, including those from All India Institute of Medical Sciences (AIIMS) Gorakhpur and Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, wrote.

Schools from Guwahati and Deoghar were found to have the highest proportion of adolescents in the high-risk and moderate-risk categories, while those in Nagpur and Puducherry were characterised by predominantly low-risk profiles.

Prevalence gap between Guwahati and Nagpur was 35.1 percentage points, of which nearly 40 % could be explained by observed characteristics, mainly school characteristics, socio-demographic and economic factors, and personality traits, the authors said.

Further, a higher digital exposure was also associated with an elevated risk, as was a more favourable attitude towards substance use. Male teenagers were found to have lower odds of higher substance use risk than females.

The researchers assessed substance use risk by analysing the participants’ responses to the World Health Organization’s (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Personality traits were assessed using the Substance Use Risk Profile Scale (SURPS).

Few studies have examined multi-substance risk using standardised tools such as the WHO ASSIST, the researchers said.

They added that limited evidence is available on how substance use risk varies across diverse settings in India.

“This study provides multi-site self-reported adolescent substance use risk in India using a standardised risk classification (WHO ASSIST) in selected schools across six districts,” the team wrote.

Key modifiable factors associated with a higher risk of substance use included accessibility to substances, digital exposure, and risky behavioural environments, while social engagement shows a protective effect, they said.

The findings suggest that contextual environments drive substance use risk in teenagers in India, which has important implications for policy and programme, the researchers said.

Prevention strategies could benefit from moving beyond general, awareness-based approaches to context-specific, multi-level interventions, they said.

Strengthening regulatory enforcement to reduce accessibility, addressing digital exposure through media literacy, and scaling peer-led models such as the Community Based Peer-Led Intervention (CPLI) within the School Health Programme may support prevention efforts, the team said.