Determinants of illicit substance use among young adults in a coastal town of South India: A mixed-methods study
Department of Community Medicine, ESI-PGIMSR, Medical College and Hospital and ODC (EZ) Joka, Kolkata, West Bengal, India
Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
Address for correspondence: Dr. Divya A. Prabhu, Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal - 576 104, Karnataka, India. E-mail: dv.pai@manipal.eduAbstract
Background:
Illicit substance use is a major social issue affecting youth worldwide. Early identification of its drivers is essential to implement effective interventions and protect youth from its harmful consequences.
Aim:
To examine patterns and risk factors of illicit substance use among young adults and explore perceptions of students and teachers on the issue.
Methods:
An explanatory sequential mixed-method study was conducted over 2 years, among 2,170-degree college students in Udupi taluk. A cross-sectional study identified risk factors, followed by four focused group discussions with students and teachers to explore perceptions. Tobacco and alcohol use was excluded. Binomial logistic regression analysed the factors associated with substance use, while deductive thematic analysis was applied to qualitative data; findings were integrated through data triangulation.
Results:
1.8% participants reported lifetime illicit substance use. The mean initiation age was 19 (SD 1.4) years, with cannabis used by 74.3%. Substance use was associated with male gender, lack of parental awareness of children’s whereabouts, poor knowledge, and negative attitudes. Drivers included curiosity, pleasure-seeking, festivities, stress management, relationship breakups, peer pressure, career stress, pre-sport use, and social media influence.
Conclusions:
Illicit substance use among young adults arises from a complex interplay of factors. The findings highlight the need for screening and brief intervention, along with educational interventions to improve awareness among adolescents and teachers to prevent substance use.
INTRODUCTION
Illicit substance use is a grave public health issue, affecting nearly 296 million people aged 15 to 64 annually worldwide—a 23% increase over the past decade. There is a wide geographical variation in the prevalence and treatment of substance use disorders, with opioid use disorders predominating in Europe and parts of Asia, cocaine use disorders in Latin America, cannabis use in Africa, and methamphetamine in East and South-East Asia.[1] In India, cannabis and opium use is escalating at an astounding rate with 2.8% and 2.1% of the population using these substances, respectively.[2] Whereas a few studies in Karnataka have reported the prevalence of illicit substance use ranging from 2.9% to 8.6%.[34]
In contrast to the United States, where the age of initiation into illicit substance use can be as early as 12 years, studies in India indicate that substance use typically begins at a much older age.[56] Adolescent and young adults are more vulnerable to addiction due to factors such as a strong tendency toward experimentation, inquisitiveness, peer pressure, challenging authority, and poor self-esteem.[78910] Changes in societal and cultural norms, competitive way of life, and decline in family bonds further intensifies the situation. Early initiation of illicit substance use, especially during formative years, leads to behavioral transgressions, decreased competence, and increased medical expenses, thereby affecting their academic, social, and life skills development.[11121314]
Early identification of risk factors for illicit substance use among youth, coupled with timely intervention, can prevent their inclination toward substance use and protect them from its undesirable consequences.[15] Though there are studies that have explored the risk factors of tobacco and alcohol use among youth in this region, very little is known about the risk factors of illicit substance use.[1617] To address this gap, a college-based mixed-methods study was conducted to identify the pattern and risk factors associated with illicit substance use and to explore the perceptions of students and teacher on this issue which will be reflected in two phases
MATERIAL AND METHODS
An explanatory sequential (Quant-Qual) mixed-methods study was conducted, among 2,170-degree college students in Udupi taluk, one among the seven administrative subdivisions (talukas) of Udupi district over a 2-year period i.e. December 2020 to December 2022. Students from 12 (five government colleges and seven private colleges) out of 20-degree colleges were enrolled in the study. Approval was obtained from the institutional ethics committee (reference number: IEC 132/2021). The study was also registered with the Clinical Trial Registry of India (CTRI/2021/08/035643). It was conducted in two phases: a quantitative study followed by qualitative study.
Quantitative study
This was a cross-sectional study conducted to identify the pattern and risk factors associated with illicit substance use. A pre-designed and pre-tested semi-structured questionnaire was used to collect data on baseline characteristics, usage of illicit substances, home environment, interpersonal relationships, scholastic performance, and knowledge and attitude towards substance use. Public health specialists established the face and content validity of the questionnaire. The questionnaire was pilot tested to ensure feasibility. Socio-economic status was determined using the modified B.G. Prasad scale.[18] The 9-question Patient Health Questionnaire (PHQ9) which was used for assessing depression had a sensitivity and specificity of 88%.[19] The operational definition of “illicit substance use” in this study was the “use of mind-altering illicit substances, particularly those prohibited under the Narcotic Drugs and Psychotropic Substances Act, 1985.”[20] Tobacco and alcohol use was not taken into consideration as extensive studies exploring this topic in this region already exists.
Using purposive sampling, researchers listed all degree colleges from university websites and acquired permission from college principals. College Coordinators facilitated the arrangement of visits, and all students present in classrooms were requested to participate after the study was described and written consent obtained. Students, who declined participation left the classroom, and teachers were not present during data collection to safeguard privacy. Confidentiality and anonymity were upheld, and students requiring help were referred to a clinical psychologist. Out of 2,900 students approached, 2,170 participated. The minimum required sample size was estimated as 1,929 based on Hansadah and Sonalika’s study which reported a 28% prevalence of adequate knowledge, with 8% precision and 20% nonresponse rate.[21]
Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 16 for Windows (SPSS Inc., Chicago). Descriptive statistics were reported as percentages and proportions. Univariate logistic regression analysis was conducted to study the risk factors, and variables with a P value < 0.2 were selected for multivariate analysis to identify independent predictors of substance use. Results were expressed as crude and adjusted odds ratios (ORs) with 95% confidence intervals. A P value < 0.05 was considered statistically significant for multivariate logistic regression analysis.
Qualitative study
Four focus group discussions (FGDs) were conducted—two each among students and teachers at their respective colleges—to assess their perceptions regarding substance use. Separate FGDs for users could not be conducted as personal identifiers were avoided while conducting the quantitative study for ethical reasons. Though the selection of colleges and students was based on convenient sampling, the colleges with greater proportion of substance users in the first phase were selected. Also, diversity in sample size was assured by selecting equal number of male and female students from different academic streams.
The FGD script consisted of 12 open-ended questions for teachers and 16 for students. The research team developed and refined the script based on the study objectives, review of relevant literature, and pilot testing. The script focused on participants’ opinion regarding the harms of substance use, its risk factors, and recommendations for preventing substance use at both the college and community levels.
Each FGD included 8–10 participants, and each session lasted approximately 40–50 min. Participants were briefed on the study objectives, and the conduct of discussion and written informed consent was obtained for both participation, audio recording and documentation of discussion. The FGDs were conducted in English, audio recorded and transcribed verbatim. Measures were taken to ensure the confidentiality and anonymity of their responses throughout the data collection, analysis, and reporting processes. Codes were assigned to the participants viz. for FGD among students, girls and boys were coded G and B respectively. Whereas in FGDs among teachers they were coded T and Te in 2 FGDs respectively
The transcripts were carefully reviewed to remove personal identifiers and ensure accuracy. Qualitative data were summarized based on the identified themes. The data were indexed according to themes and sub-themes, allowing for development of the final framework. This framework was then charted by theme to synthesize the data and aid interpretation. A deductive method of analysis was employed.
Triangulation
The results of the quantitative and qualitative studies were merged during the interpretation stage to enhance understanding and contextualize the quantitative findings.
RESULTS
Out of 2,170 students, 39 (1.8%) reported having consumed substances at least once in their lifetime. Most users (82%) were under 20 years old, and most (76.9%) were males. The predominant religion among users was Hinduism (69.2%). Over half (53.8%) were pursuing a BSc course. Regarding parental occupations, fathers of nearly one-third of users (28.2%) were professionals, followed by businessmen (20.5%) and semiskilled workers (20.5%). Most mothers (60.6%) were homemakers. Approximately one-third (30.8%) of users came from affluent families in the upper socio-economic class. A quarter of users (25.6%) were staying in hostels, while one-third (35.8%) lived away from their families. Additionally, 12.8% of users were engaged in part time jobs. [Table 1]
| All participants (n=2,170) | Substance users (n=39) | |
|---|---|---|
| Age (years), mean (SD) | 19 (±1.38) | 19 (±1.38) |
| ≤20 | 1823 (84) | 32 (82.1) |
| >20 | 347 (16) | 7 (17.9) |
| Sex | ||
| Female | 1329 (61.2) | 8 (20.5) |
| Male | 837 (38.6) | 30 (76.9) |
| Others | 4 (0.2) | 1 (2.6) |
| Course | ||
| Commerce | 1018 (46.8) | 7 (17.9) |
| Science | 802 (37.0) | 21 (53.9) |
| Professional | 197 (9.1) | 2 (5.1) |
| Arts | 153 (7.1) | 9 (23.1) |
| Religion† | ||
| Hindu | 1826 (85.8) | 27 (69.2) |
| Christian | 144 (6.7) | 8 (20.5) |
| Muslim | 146 (6.8) | 4 (10.3) |
| Others | 11 (0.5) | 0 |
| Father’s educational level† | ||
| Illiterate | 32 (1.5) | 1 (2.6) |
| Up to class 12 | 1339 (61.7) | 17 (43.5) |
| Graduate and above | 752 (34.6) | 20 (51.3) |
| Mother’s educational level† | ||
| Illiterate | 47 (2.2) | 0 |
| Up to class 12 | 1375 (63.4) | 16 (41) |
| Graduate and above | 692 (31.8) | 21 (53.8) |
| Father’s occupation† | ||
| Professional/white collar/Business | 867 (46.4) | 19 (48.7) |
| Skilled worker | 359 (16.5) | 4 (10.3) |
| Semi-skilled/unskilled | 602 (27.8) | 8 (20.5) |
| Pensioner/unemployed | 38 (2.0) | 0 |
| Mother’s occupation† | ||
| Professional/Business | 280 (14.7) | 10 (30.3) |
| Skilled/semiskilled worker | 177 (9.3) | 3 (9.1) |
| Home maker | 1423 (65.6) | 20 (60.6) |
| Socio-economic status† | ||
| Upper class | 753 (61.2) | 14 (35.9) |
| Middle class | 282 (22.9) | 4 (10.2) |
| Lower class | 195 (15.8) | 1 (2.6) |
| Who else stays with subject† | ||
| Family | 1402 (64.7) | 16 (41) |
| Single parent | 281 (12.9) | 4 (10.2) |
| Friends | 155 (7.2) | 8 (20.5) |
| Stays alone | 137 (6.3) | 6 (15.3) |
| Grandparents only/siblings only | 77 (3.5) | 1 (2.7) |
| Present place of residence† | ||
| Home | 1489 (68.8) | 20 (51.3) |
| Hostel | 339 (15.6) | 10 (25.6) |
| Paying guest | 119 (5.5) | 5 (12.8) |
| Birth order | ||
| Single child | 579 (26.7) | 10 (25.6) |
| Oldest | 755 (34.8) | 11 (28.2) |
| Youngest | 620 (28.6) | 14 (35.9) |
| Middle | 216 (9.9) | 4 (10.3) |
| Involvement in any part time job | 145 (6.7) | 5 (12.8) |
Reasons for substance use
The mean age of initiation of substance use among users was 19 ± 1.39 years. Cannabis was the introductory drug for the majority (74.3%) and remains the most used substance (n = 11;28.2%) among current users, i.e. those who have used the substance in the past 30 days. Other substances currently being used included LSD (n = 1; 2.5%), amphetamine (n = 1; 2.5%), MDMA (n = 1; 2.5%), and cocaine (n = 2; 5.1%). One fourth of users (10;25.6%) reported initiating substance use out of curiosity, while others cited reasons such as personal pleasure (2;5%), part of Holi festivities (3;7.5%), stress relief (4;10.2%), depression (1;2.5%), or coping with a breakup (1;2.5%). Among current users, the reasons for substance use were for fun (6;15.4%) and to alleviate stress and anxiety (3;7.6%). One-third (33.3%) reported using substances at parties with friends, while a few admitted to using them at home, before exams, or during sports activities.
Pattern of substance use
Nearly one-fourth of users (10;23.1%) reported using substances only once or twice in their lifetime, while 23% indicated using substances more than once in the past year. Additionally, over a quarter of participants (11;28.2%) reported making attempts to quit substance use.
Mental health of users versus non-users
As compared to non -users (1248;58.4%) greater proportion of users (31;79.4%) were screened positive for depression, although the difference was not statistically significant (P = 0.536). Table 2 depicts the association between sociodemographic and environmental factors and substance use. Univariate analysis revealed that substance use was more prevalent among males, Hindus, Arts students, those with well-educated mothers, among hostelites, individuals with less strict parents, those whose parents were unaware of their whereabouts, unsupportive teachers, unsatisfied relationship with mother, good knowledge about substances, and a negative attitude towards substance use.
| Non-users (n=2131) | Users (n=39) | Crude OR (95% CI) | P | Adjusted OR† (95% CI) | P | |
|---|---|---|---|---|---|---|
| Sex | ||||||
| Female | 810 (38.0) | 9 (23.1) | 1 | 0.001* | 1 | 0.003* |
| Male | 1321 (62.0) | 30 (76.9) | 6.1 (2.8, 13.4) | 4.5 (1.6, 12.2) | ||
| Course | ||||||
| Commerce | 958 (45.1) | 7 (17.9) | 1 | 0.001* | 1 | 0.080 |
| Science | 781 (36.6) | 21 (53.8) | 0.2 (0.1, 0.6) | 0.2 (0.6, 0.7) | ||
| Professional | 245 (11.5) | 2 (5.1) | 0.7 (0.1, 3.2) | 0.5 (0.07, 2.9) | ||
| Arts | 144 (6.8) | 9 (23.1) | 0.1 (0.04, 0.3) | 0.2 (0.05, 1.0) | ||
| Religion | ||||||
| Hindu | 1799 (86.2) | 27 (69.2) | 1 | 0.004* | 1 | 0.570 |
| Others | 289 (13.8) | 12 (30.8) | 1.7 (0.6, 5.0) | 0.7 (0.3, 2.0) | ||
| Mother’s educational level | ||||||
| Graduate and above | 671 (32.3) | 21 (56.8) | 1 | 0.008* | 1 | 0.851 |
| Class 10–12 | 537 (25.8) | 4 (10.8) | 4.2 (1.4, 12.3) | 1.4 (0.4, 4.6) | ||
| Less than class 10 | 869 (41.9) | 12 (32.4) | 2.2 (1.1, 4.6) | 1.3 (0.4, 3.6) | ||
| Present place of residence | ||||||
| Outside | 443 (23.1) | 16 (43.6) | 1 | 0.008* | 1 | 0.146 |
| Home | 1473 (76.9) | 22 (56.4) | 0.4 (0.2, 0.8) | 0.5 (0.2, 1.3) | ||
| Parents aware about child’s whereabouts | ||||||
| Yes | 1623 (95.0) | 25 (80.6) | 1 | 0.001* | 1 | 0.006* |
| No | 86 (5.0) | 6 (19.4) | 4.5 (1.8, 11.3) | 4.5 (1.5, 13.0) | ||
| Supportive teacher | ||||||
| Yes | 1461 (86.1) | 18 (60.0) | 1 | 0.001* | 1 | 0.246 |
| No | 236 (13.9) | 12 (40.0) | 0.2 (0.1, 0.5) | 0.5 (0.2, 1.4) | ||
| Knowledge | ||||||
| Good | 601 (28.2) | 18 (46.2) | 1 | 0.004* | 1 | 0.025* |
| Poor | 1530 (71.8) | 21 (53.8) | 2.6 (1.3, 5.0) | 2.9 (1.1, 7.3) | ||
| Attitude | ||||||
| Positive | 1852 (86.9) | 21 (53.8) | 1 | 0.001* | 1 | 0.012* |
| Negative | 279 (13.0) | 18 (46.1) | 5.6 (2.9, 10.8) | 3.2 (1.3, 7.9) |
On univariate analysis, variables like gender, course, religion, mother’s education level, present place of residence, strict parents, parents aware about their child’s whereabout, supportive teachers, knowledge and attitude about substance use were found to be significantly associated with substance use.
In a mutually adjusted model retaining only independently significant associations, substance use was significantly higher among males (AOR = 4.5, 95% CI 1.6, 12.2), students whose parents were unaware of their whereabouts (AOR = 4.5, 95% CI 1.5, 13.0), those with poor knowledge (AOR = 2.9, 95% CI 1.1, 7.3), and negative attitude towards substance use (AOR = 3.2, 95% CI 1.3, 7.9) [Table 2].
Qualitative study
Four FGDs were conducted—two each with teachers and students. A total of 18 students and 17 teachers participated in the discussions. The findings from the FGDs were categorized into four main themes: commonly used substances, age of initiation, physical environment, and sociocultural factors.
- Commonly used substancesThe participants reported a range of commonly used substances among students in Udupi taluk. Among students, substances such as weed, cocaine, opium, heroin, MDMA, and brown sugar were more frequently mentioned, while among teachers, cannabis, marijuana, steroids, and gutka were perceived to be habitually used. Few teachers said they have seen students using some kind of tablets but were unsure of the exact nature of these substances. Additionally, several teachers mentioned that students abused products like Iodex balm and Benadryl cough syrup. However, some teachers and students believed that substance use was not common in the colleges of Udupi taluk, with alcohol and cigarette addiction perceived to be frequently used.“Here in campus nothing like that has been seen as in they have never been caught but tobacco smoking in campus has been seen.” (T1)
- Age of initiationSeveral students stated that most of their peers in the 16–18 age group consumed substances, while a few students and teachers suggested that the common age group for substance use was 18–25 years.“I know someone who started at the age of 13 is a high school dropout now. Grows own weed plant.” (G6)
- Physical environment
- Availability of substancesMost students stated that these substances could be procured from peers, dealers, or online retailers.“My friend grows ganja in his own house” (G6)Teachers assumed that substances could be obtained from “paan walas” or senior students.The students revealed that youngsters often consume substances in secluded areas such as industrial areas, fields, forests, or clubs.
- Lack of disciplinary actionThe teachers unanimously voiced about the prevailing guidelines on substance use, which were uniform across all colleges. While some teachers expressed dissatisfaction with the existing redressal mechanism, certain students were unaware of the presence of counselling cells in their colleges.“I saw one student on weed who used to come high to class. No serious action was taken as student was quiet in class. When he used to start laughing simple disciplinary actions were taken like sending him out of the class. He himself said he used drugs. He was not sent for counselling.” (Te4)
- Socio-cultural factors
- Individual factorsThere was a consensus among students that factors such as depression, peer pressure, career stress, relationship breakups, curiosity, recreation, the influence of movies, sports, and exam-related stress predispose youth to substance use.“There is too much of academic stress and career burden, no one cares about mental health and no one asks how are you feeling. So, people do not know what to do and rely on drugs and goes into depression. As groupism is there cannot talk to friends” (G2)“Some drugs make memory very strong. So, some students, take it, so that they can remember before an exam. Yeah, they take it a lot. Because there is so much to study” (G4)Teachers opined that factors such as the influence of movies and celebrities, loneliness, peer pressure, an inability to cope with stress, and easy availability of substances were key drivers of substance use.“OTT platform has no censoring. So, youth is exposed to these substances.” (T3) “Some students see their friends. Not strong enough to judge what is right or wrong….just follow the trend” (T1) “no one cares about mental issues, no one asks how you feel. So, people don’t know what to do and rely on drugs” (T2)
- Family relationsStudents opined that strained relationship with parents, including uninvolved parents or overtly strict parenting and communication barriers, were among the drivers of substance use. Few students quoted verbatim:“Strict parents make children rebellious and they want to do it” (G7)“If parents monitor their children properly it can be prevented.” (G9)“…children learn from parents so they should change their habits” (B5)“Parents should understand the feelings of children, they should first ask why they are taking drugs then talk to them and parents should spend daily 1 hour with children.” (G6)This view was supported by majority of teachers, who also emphasized that parents play a pivotal role in their children’s life.“Family members should try to reduce their psychological insecurities. Proper care and affection should be given. Parents should monitor the children, their activities” (Te4)“Especially if they do not give time, they think they will compensate by giving money. They should supervise the children.” (T6)“If they are ignored, they rely on drugs to find happiness in drugs.” (G2)
Overall, our qualitative study revealed that participants perceived the prevalence of illicit substance use in Udupi to be low, with the age of initiation as early as 13 years. Cannabis was perceived as the most habitually used substance. Depression, peer pressure, career and relationship stress, curiosity, influence of movies, and strained relationship with parents were identified as some of the drivers of illicit substance use. Participants expressed dissatisfaction with the existing redressal mechanisms to address the issue of illicit substance use.
Triangulation
Both the quantitative and qualitative results displayed concurrence on several points such as cannabis being the most common substance used by students, early initiation of substance use during teenage years, and the role of parental supervision in shaping students’ choices. The quantitative data revealed independent predictors of substance use like gender, lack of parental awareness, poor knowledge and negative attitude toward substance use while the qualitative data elucidated these further by unfolding issues like stress from studies, peer influence, and challenges in family relationships. Interviewees also mentioned the use of some substances, like certain over-the-counter products, that were not covered in the quantitative study. While data from both the components approved on the uncommonness of illicit drug use compared to alcohol and tobacco, qualitative provided more detail about social and school-related factors, such as limited support and counseling for students. Combining these results provides a clearer picture of substance use and its causes among students in Udupi taluk.
DISCUSSION
Of the 2,170 surveyed students, only 1.8% reported lifetime substance use, a finding supported by our qualitative study. The associated factors included male sex, parents unaware of their children’s whereabouts, negative attitude, and lack of knowledge about substance. Although substance use is common among youth in India,[2] it is not common in this region of the country, like rates reported in prior studies.[34] Cannabis was the most used substance, followed by LSD, amphetamines, ecstasy, and cocaine. Qualitative data echoed this, identifying cannabis, cocaine, opium/heroin, MDMA, steroids, and gutka as commonly used. These findings align with UNODC World Report 2023,[1] the National Drug Dependence Treatment Centre survey for Ministry of Social Justice and Empowerment (MSJE) and via the National Sample Survey Office (NSSO),[2] and other studies.[2022] In contrast, Toprak et al.[23] found minor tranquilizers most common in Turkey, followed by inhalants and cannabis.
Among users, four-fifth were under 20 years, with a mean initiation age of 19 years. Teachers noted initiation typically occurred between 18 and 25 years. Similar age of initiation (i.e. 20 years) was noted by Kermode et al.[6] In contrast, earlier initiation ages were observed by Tsering et al.[10] (mean 13 years in urban areas and 14 years in rural areas) and Mogan et al.[5] (mean 16 years). Regional differences in the age of substance use initiation, among youth may be attributed to variations in substance availability and cultural norms. Substances were obtained from peers, seniors, paan walas, dealers, and online sources, consistent with previous research that showed that students procured substances from slums near their colleges.[24] Users consumed substances in secluded locations such as industrial areas, fields, and forests; findings are similar to Geleta et al.’s[25] “work areas and green zones” that allows youth to consume substances in privacy and the opportunity to socialize with friends.
Depression was more prevalent among users (79%) than non-users (58%), consistent with previous regional study that reported a prevalence of 40%.[26] However, the use of self-administered screening tools may overestimate actual rates. A two-stage assessment approach is recommended for more accurate estimation of depression prevalence. Males were more likely to use substances than females (AOR 4.5, 95% CI 1.6, 12.2), consistent with studies on youth in urban primary health centers in Delhi,[5] 10th graders in Istanbul,[27] and college students in Turkey.[23] This difference likely reflects higher risk-taking and easier access to substances in males, alongside societal stigma deterring use among female.[28]
Students living at home were less likely to use substances than those living away (AOR 0.5, 95% CI 0.2, 1.3), aligning with findings from India, Istanbul, and the US.[72729] Increased risk among hostel residents may stem from wider social circles, greater freedom, and reduced parental supervision.[30] Limited parental supervision has been linked to higher substance use in previous studies from Estonia, the US, and Switzerland.[313233] Parents play a vital role in modelling health behaviors and monitoring substance use.[34] Poor knowledge about substances nearly tripled the risk of use (AOR 2.9, 95% CI 1.1, 7.3), possibly reflecting users’ continued use despite awareness of harms. Similar findings were reported in other Indian studies[935]; however, studies from Cairo and Taiwan did not find any such association.[3637] Possibly, the cultural differences mediate such differences, which needs further study. Negative attitudes also increase risk (AOR 3.2, 95% CI 1.3, 7.9), consistent with studies in Cairo and Nairobi.[3638] Substance use prevention programs in adolescents should target enhancing knowledge and foster resilience and coping strategies.[3940]
Key drivers included curiosity, pleasure-seeking, festivities, coping with stress and depression, breakups, peer pressure, career stress, sports preparation, and social media influence, paralleling findings by Muruganandam et al. and Poojary et al.[4142] In contrast, Kenyan and Ethiopian studies highlighted access to money, poor parenting, unemployment, lack of recreation, weak legal systems, and inadequate policies.[2538] Alhyas et al.[43] also noted boredom and false sense of social acceptance as reasons for substance use in youth. School-based programs with components of skills training and normative education have been recommended for universal and indicated prevention for substance use in Indian setting.[44]
Our study has several limitations. The use of a self-administered questionnaire to address sensitive topics such as substance use may have led to underreporting due to students’ reluctance to disclose socially undesirable behaviors, potentially underestimating prevalence. Additionally, the taboo nature of the subject in our population may have caused both students and teachers to be less forthcoming during FGDs. Female users might have been underrepresented because of societal stigma. The relatively small sample size of substance users limited the precision of estimates and the ability to explore population heterogeneity. Since FGDs were conducted using convenience sampling, selection and observer biases may have influenced the findings. Despite repeated probing, the study was unable to identify specific weaknesses in the college’s redressal mechanisms for illicit substance use.
CONCLUSIONS
This study reports a relatively low prevalence of substance use among college students in Udupi taluk. However, risk was higher among males, students lacking parental supervision, and those with poor knowledge and negative attitudes toward substance use. These findings underscore the importance of routine screening and brief interventions—evidence-based strategies proven effective in this population.[4546] Sensitization programs targeting both students and teachers should be implemented to improve awareness and address negative perceptions. Additionally, involving parents through parent-teacher meetings can help foster supportive home environments and strengthen protective factors against substance use.
Ethical approval
Approval was obtained from the institutional ethics committee of Kasturba Medical College and Kasturba Hospital (reference number: IEC 132/2021). The study was also registered with the Clinical Trial Registry of India (CTRI/2021/08/035643).
Conflicts of interest
There are no conflicts of interest.
Acknowledgements
We sincerely thank the principals and faculty co-ordinators of the participating colleges for their constant support throughout the study. We also thank the students who actively participated in the study.