Smoking, Alcohol Consumption, and Illegal Substance Abuse among Adolescents in Sri Lanka: Results from Sri Lankan Global School-Based Health Survey 2016

Background. Adolescence is defined by the World Health Organization (WHO) as “the transition period from childhood to adulthood”. Increases in autonomy during this period, willingness to experiment, and peer influence create an environment of taking high-risk decisions influencing adolescent health, such as substance abuse and smoking. The current study was conducted to estimate the prevalence of smoking, alcohol consumption, and illegal substance abuse and their determinants on in-school adolescents using data from the Global School-based Student Health Survey, Sri Lanka in 2016. Methods. A cross-sectional survey was conducted among 3,650 students using a self-administered questionnaire in government schools. Weighted prevalence was calculated, and logistic regression analysis was conducted to determine the correlates. Results. The prevalence of current alcohol, smoking, smokeless tobacco consumption, and substance abuse, 30 days before the survey, was 3.4% (95% CI 2.6 - 4.3), 3.6% (95% CI 2.5-5.0), 2.3% (95% CI 1.5-3.7), and 2.7% (95% CI - 1.7-4.2%). Male sex and involvement in physical fighting were independently associated with increased risk in all four substance categories assessed. Multivariate analysis using multiple logistic regression revealed that only the male sex and involvement in physical fighting were correlates for four substance categories assessed when confounding effects of other variables were accounted for. Being in the 16-17 age category, parents’ tobacco use and seeing actors consuming alcohol on TV increased the risk of alcohol consumption, smoking, and smokeless tobacco. Having ever attempted suicide was positively associated with increased risk for alcohol consumption, smoking, and illegal substance abuse. Conclusion. Alcohol use, smoking, smokeless tobacco use, and illegal substance abuse by students remain a concern in Sri Lanka and implementing life skills-based interventions at schools is recommended