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Official websites use. Share sensitive information only on official, secure websites. Corresponding author: U. Venkatesh; Email: venkateshmbbs gmail. Substance use is a complex condition with multidimensional determinants. The present study aims to find the prevalence and determinants of substance use among young people attending primary healthcare centers in India. A multicentric cross-sectional study was conducted across 15 states in India on 1, young people 10—24 years attending primary health centers. The degree of substance involvement was assessed and multivariate regression analysis was conducted to determine the risk factors of substance use. The prevalence of substance use was Among the substance users, Tobacco Sociodemographic determinants included higher age, male gender, urban residence, positive family history, northeastern state residence and lower socioeconomic class. High substance use prevalence among young people in Indian healthcare centers underscores the urgency of targeted intervention. Insights on determinants guide effective prevention strategies for this complex public health issue. Our study findings align with the global scenario where tobacco use remains a significant public health concern. India, being the second largest consumer of tobacco globally, faces substantial health risks associated with its use. The study also highlights the high prevalence of alcohol and cannabis use among young individuals. The early initiation of substance use underscores the urgency of targeted interventions during early adolescence. The sociodemographic determinants identified, such as age, male gender, urban residence, family history, and lower socioeconomic class, provide valuable insights for developing targeted prevention and intervention strategies. These determinants mirror findings from previous research, emphasizing the need for multifaceted approaches that consider social, economic and cultural factors influencing substance use. The findings underscore the need for tailored interventions for regional differences and cultural nuances. The call for interventions addressing the accessibility of substances emphasizes the importance of policy measures to restrict easy access, especially considering that friends are reported as the primary source of introduction to substances. Substance use includes the misuse of prescription drugs; the use of tobacco, alcohol and illicit drugs i. In , it was reported that around 5. Globally, half a million deaths annually are attributable to substance use and contribute about 1. Tobacco use is the single largest source of preventable deaths worldwide. Though alcohol is the most common substance used worldwide, tobacco is highly prevalent in India. India is the second largest tobacco consumer globally, and around one-fourth of adults in India consume tobacco Centres for Disease Control and Prevention CDC , Among persons aged 13—18 years, the prevalence of ever tobacco users was Few other studies showed that a majority of adults initiate substance use in their youth Sharma and Tyagi, In current trends, cannabis use among youth has been gradually increasing, and very few studies were conducted to assess the pattern and determinants Kuepper et al. Studying substance use in adolescence is crucial due to heightened vulnerability to initiation during this critical developmental phase. Early substance use can lead to enduring physical, mental and cognitive impacts, elevating the risk of future substance use disorders and associated problems like educational underachievement Balyakina et al. Behaviors established during this period often persist into adulthood, emphasizing the need for early identification and intervention to prevent harmful habits. Moreover, the profound developmental changes in the adolescent brain, especially in decision-making and impulse control areas, underscore the long-term consequences of substance use. Social dynamics and peer influence significantly contribute to substance initiation among youth, influencing the design of targeted interventions. Substance use among young people not only poses individual risks but also contributes to broader public health issues, necessitating strategies that address societal impacts Tsering et al. Research in this area informs evidence-based policies and prevention efforts tailored to specific age groups, presenting valuable opportunities for early intervention programs that mitigate the negative consequences of substance use Boys et al. Primary health centers PHCs serve as the frontline of healthcare and first point of contact with community, making them pivotal in identifying and addressing substance use issues early on. Early detection and intervention at PHCs can prevent the escalation of substance use disorders, reducing the burden on higher levels of healthcare. Moreover, integrating substance use studies into PHCs aligns with a comprehensive approach to healthcare, addressing not only physical health but also mental and behavioral aspects, thus promoting holistic well-being in the community. Furthermore, while national surveys offer insights into the prevalence of individual substance use, they do not conduct a comprehensive examination of all types of substance use within a single study. Additionally, there is a limited exploration of the factors associated with substance use in these surveys. The present study aimed to estimate the prevalence and determinants of substance use among young people attending rural and urban primary health centers in India. We conducted a multicenter, cross-sectional study across 15 states in India one medical college from each state from March to October Figure 1 , Supplementary material S2. The participants were young people 10—24 years attending rural and urban primary health centers of those colleges. Only those in need of emergency management were excluded from the study. The eligible participants were chosen by consecutive sampling. Note : Tobacco was consumed by More than one substance was consumed by Injectable drugs were used by 3. Tobacco and alcohol had median scores of 15 11—22 and 16 6—26 , respectively. Among opioid users, majority Substances were introduced to the users majorly by friends Considering the NFHS 5 data for tobacco use rural of Accounting for a design effect of 4. Shea et al. The study sites were chosen by convenience sampling, representing all five zones and the northeastern NE part of India Government of India GoI , After a review of literature and discussion with subject experts, a predesigned, semi-structured questionnaire was used to capture sociodemographic details and determinants of substance use. ASSIST involves screening for tobacco products, alcoholic beverages, cannabis, cocaine, amphetamine-type stimulants, inhalants, sedatives, hallucinogens, opioids and intravenous substance use based on lifetime use. Substance involvement score was calculated individually for each substance and divided into grades 1 low , 2 moderate and 3 high based on the use of substances in the past 3 months as per the ASSIST guidelines. By norms, the medical colleges in India have rural and urban training at PHCs. All eligible participants attending OPD for their illness were approached and explained about the study. Data was obtained by one-on-one interview administered via a Google form questionnaire. Operational definitions : Substance use was defined as the use of licit or illicit substances other than when medically indicated, such as tobacco, alcohol, cannabis, cocaine, amphetamines, inhalants, sleeping pills, hallucinogens, opioids and intravenous drugs World Health Organization The standard WHO definition of young people as an overlap of adolescents 10—19 years and youth 19—24 years , which included those 10—24 years, was adopted WHO, ,3. As per the ASSIT tool, the prevalence of substance use was calculated based on self-reported data for lifetime use. The scoring of substance use was based on the past 3-month usage. A person involved in moderate to high use of any one of the substances was considered in the moderate to high involvement category. The prevalence of substance use was calculated and mean scores were calculated for substance involvement scores. Logistic regression was done to quantify the association between substance use and covariates such as age, sex, education, occupation, family history of substance use, socioeconomic status and family type. For multivariate regression in assessing both substance use and severity of involvement, adjustment was done for age, gender, type of family, residence, marital status, family history, category of state, education or employment status and the socioeconomic class the model fit showed significant omnibus test and nonsignificant Hosmer and Lemeshow test values. Ethical clearance was obtained from the institutional ethics committee of both the primary institute AIIMS, Gorakhpur and of the individual sites. Written informed consent from adults and assent from accompanying parents in case of minors was obtained before enrolment into the study. If there was no parent accompanying, the study was explained to the minors and, if willing to participate, they were asked to come along with their parents to the PHC. The privacy of the participants was ensured during data collection. The study was performed on a sample of 1, participants in the age group of 10—24 years from 15 states across India. The mean age of the participants was Substance use was observed in family members of Tobacco was the most common The overall prevalence of substance use was Females had a lower prevalence The mean age of initiating substances was Christians had a higher prevalence In the northeastern states, In other words, among Christians in northeastern states, People in the age group of 20—24 years, males, urban residents, northeastern residence, married, employed, those with a positive family history and falling under lower socioeconomic class had a significantly higher proportion of substance use Table 2. Though family type and marital status were significant on bivariate analysis, it was not so on adjusting for other variables Table 2. Nearly one-third reported that tobacco and alcohol products were easily accessible. One to three percent reported that substances, including cocaine, amphetamine, inhalants, sedatives, hallucinating drugs and opioids, were available within their premises Table 3. Family history of substance use, place of residence and type of family did not statistically affect the severity of tobacco score. The present study reports that the prevalence of substance use among people in the age group of 10—24 years is Corroborating with the current findings, the study by Baba et al. The prevalence rates in our study exceeded those found in studies on school children in Turkey While the inclusion of higher age groups in our study may explain the variance, higher prevalence rates The current finding that more than a quarter Notably, GATS reports the initiation age for tobacco use at Consequently, a meaningful comparison of the prevalence rates between the current study and GATS can be undertaken taking into account the age range and reported age of tobacco initiation in the respective studies. The GYTS also reported a slightly higher prevalence of tobacco users 8. In a study on pre-university students Bhojani et al. This might be because of the high prevalence of substance use in the northeastern states. The current study reported a significantly higher prevalence The higher prevalence in these states may be attributed to their porous borders, making legal enforcements more challenging, and more recreational tourism. The current study showed that tobacco was the most common substance used, followed by alcohol. Similar reports were evidenced in few other studies also although the source of samples for each of these studies was different Ningombam et al. Christians were the highest proportion of substance users, and of the total Christians, A study among the students of Manipur Ningombam et al. Hence, the prevalence among Christians was high probably due to the high representation of Christians in northeastern states, which had more substance users. The prevalence of substance use was much lower in the current study among those actively enrolled in school or college, and this conclusion was validated by two other studies Rani et al. The current study reported that the prevalence was significantly high among those with a positive family history of substance use, and a similar report was provided by a substance use study in Manipur Ningombam et al. In the current study, friends played a major role in the introduction of substances. The role of peers in adolescent behaviors, including substance use, is well established Kobus, ; Ningombam et al. The current study reports a higher prevalence of cannabis use 9. Delhi and Haryana, being one of the major cannabis consumers Government of India GoI , b , reported only 4. In alignment with the higher overall substance use, though cannabis use was also higher The difference might be because of the study population, as the latter Ningombam et al. Though Kashmir also has hurdles in legal enforcement Baba et al. On regression analysis, the current study reported that higher age group, male gender, place of residence, family history of substance use, geographical area, education or employment status and lower socioeconomic status were all found to be significantly associated with substance use. A study on similar population of young people attending rural health centers showed an association between substance use and male sex, lower socioeconomic level and family history of substance use Mogan et al. Male gender, higher age group and urban predominance of substance use were also reported in another study Qadri et al. Though too few studies Qadri et al. The higher prevalence in the male gender and higher age group may be due to the increased social exposure in this group. The current relation of substance use with a positive family history was also supported by other literature Singh and Gupta, ; Saxena et al. Tobacco use was significantly higher among those over 19 years of age, men, those who had never been married, people of the low socioeconomic group and those who were not living with family currently Supplementary file 3. Literature shows that an increased incidence of cigarette use was seen among people in the lower socioeconomic group Rani et al. This might be due to a lack of awareness about the ill health effects of tobacco among the lower socioeconomic group. The study could have been further expanded to assess the reason for starting substance use, associated injuries, adverse events on the road or sexual and mental behavior. Both the proportion of users and the degree of involvement were high in male gender. This might be due to social norms and stigmatization of female substance users in the Indian society. However, underreporting among females might also be a possibility. More number of people in the 20—24 years group age had higher substance involvement scores. This might indicate that the chances of addiction are higher as age increases and that interventions should be planned for younger people. While the present study provides valuable insights into the determinants of substance use among young people, there are limitations inherent in the study design. The present study was done on those attending healthcare centers and also used a convenient sampling technique to select the study sites. Hence, this may have introduced selection bias, limiting the generalizability of the findings. The study relied on self-reported data collection, which could have introduced bias affecting the accuracy of responses to certain questions related to substance use. Due to the cross-sectional design, the study was unable to establish the temporality and specificity of associations observed between determinants and substance use, thus limiting its ability to establish causality. Further research with robust study designs and more diverse samples is warranted to better understand the complex dynamics of substance use in this region. Our findings show that one-third of young people attending primary health centers engaged in substance use, with two-thirds of them initiating substance use before completing adolescence. The role of family and peers is crucial in the initiation of substance use, as two-thirds of substance users had at least one parent using substance. Higher age, male gender, urban residence, a positive family history, residing in a northeastern state and belonging to a lower socioeconomic class were determinants of substance use. To effectively combat substance use, the study recommends a multifaceted approach. Early intervention programs targeting adolescents should instill awareness and coping mechanisms against peer pressure. Comprehensive educational campaigns emphasizing the risks of substance use, particularly regarding tobacco and alcohol, are crucial. Stricter access control measures, especially in high-use regions, are recommended, including restricting underage access. Community-based initiatives promoting a healthy environment and positive peer influences should be established. Parental education programs to recognize signs of substance use and enhance communication are vital. Increased accessibility to counseling services, research and monitoring, employment opportunities, evidence-based policies and collaborative efforts between stakeholders will further contribute to mitigating substance use. Data and material supporting the results reported in the article can be obtained on reasonable request. Data collection: All Authors except A. Study conception and design: U. All authors read and approved the final manuscript. Agreement to be accountable for all aspects of the work by U. There are no competing interests. Before enrolment, adults and kids provided written informed consent, and the confidentiality of participants was maintained while collecting the data. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. 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Note : Multiple choices were applicable, hence not mutually exclusive. Venkatesh et al. Rahul Shidhaye : Handling Editor. Dixon Chibanda : Editor in Chief. Revision requested Nov Accepted Jan Associated Data. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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