Our study on the use of tobacco and illicit drugs among adolescent boys and young men in Kampala, Uganda, showed that: a) use of illicit drugs was higher among out-of-school than in-school ABYM and increased with increasing age and education levels; b) parental attention was lower among out-of-school than in-school ABYM and decreased with increasing age and education levels; and c) parental attention was low among current illicit drug users. Collectively, these findings suggest that use of illicit drugs is common among ABYM but parental attention towards them is low. These findings suggest a need to focus parental attention efforts on the most common illicit drug users.

Our finding that use of illicit drugs is higher among out-of-school ABYM is consistent with findings from Uganda, South Africa and the United States, which found that being away from school was a unique predictor of adolescent illicit drug use [25,38–40]. Most likely, illicit drug use among out-of-school ABYM may be influenced by peer pressure, since they typically spend more time around their peers than parents [41,42]. Perhaps, out-of-school ABYM continue to use illicit drugs to cope with any recurring unmet emotional, psychological or economic needs [25,43]. This is plausible, given the fact that in our study, parental attention was lower among out-of-school ABYM. Since ABYM who are out-of-school may not necessarily always be around their parents, they are more likely to have greater degree of autonomy and freedom to use illicit drugs. Our findings thus point to the likely worrying health trends among out-of-school ABYM in general, and call for a need to give them increasing attention.

We found that both past-year and current illicit drug use among ABYM increased with increasing age. Our findings are consistent with findings from the United States which found an increase in use of any tobacco products and marijuana with age [38,44], and resonate with findings from England which reported a similar pattern [45]. Altogether, these studies confirm that age is a key influencer for illicit drug use, especially among older adolescents and young men. When we further stratified our analysis by age-group, we found that use of illicit drugs sharply increases among ABYM transitioning from 15–24 years. The transition to teenage years is often a time for exploration, filled with the desire to try something new or risky. The adolescents who perceive little risk in using drugs will more readily use them [46]. While it is probable that the transition from adolescence to young adulthood is associated with increased frequency of drug use [47], we are not certain of what could have been solely responsible for the increase in use of illicit drugs among ABYM aged 15 years and older in our study, and therefore more research is warranted on this phenomenon. However, our study advances the understanding of illicit drug use among adolescents, by presenting data on the very young adolescents aged 10–14 years. Our findings thus underscore the critical importance of prevention strategies that target the young adolescent boys, which are aimed at empowering them to desist from illicit drug use initiation which would otherwise lead into future dependence.

Our study also found that illicit drug use among ABYM increased with increasing level of education. These findings are consistent with findings from Kenya, Brazil and the United States which found that illicit drug use increased as adolescents progressed through school [48–50]. Some literature suggests that increase in illicit drug use is because students are trying to cope with the intense academic pressure and expectations onto them for good school performance [51,52]. These findings suggest that schools are perhaps not drug-free environments, and call for a need to focus on instilling life skills among ABYM, for them to be able to keep up with academic demands without having to use illicit drugs. However, our study did not assess any association between illicit drug use and academic performance, and therefore, we cannot attribute the increased use of illicit drugs among better-educated ABYM to academic pressure in schools. Nevertheless, our findings suggest a need for further research to fully understand why better-educated ABYM were more likely to use illicit drugs than those with no or lower education.