Self-esteem, peer influence and associated factors driving common substances used among Ghanaian adolescents

Background: Substance use poses a significant threat to adolescent health and well-being globally, with rising rates of concern in developing countries. Several psychosocial risk factors such as peer influence and protective factors such as self-esteem are associated with substance use among adolescents. Understanding the specific psychosocial factors currently driving substance use among youth is important for developing targeted interventions. This study examines prevalence of substance use and its psychosocial correlates among Ghanaian in-school adolescents. Methods: A cross-sectional survey was administered to a random sample of 425 (242 females) Senior High School (SHS) students (Mean = 17.1 years, SD = 1.18) in Accra, Ghana. The Rosenberg Self-esteem Scale and the CAGE-AID substance abuse screening tool were used to assess self-esteem and potential substance use disorder respectively. Adolescents were also assessed on their exposure to substance friends, family, and social media. Descriptive statistics were used to characterize the sample and a multiple logistic regression models identified predictors of use for specific substances. Results: Male students, those living with relatives, and those with friends who drink alcohol were more likely to use alcohol. Students who worked while in school, or had family members who smoke, had an increased likelihood of cigarette use. Older students and those with friends who use shisha were more likely to use shisha. Interestingly, limited social media exposure and living with parents and siblings were associated with lower marijuana use. Finally, the results showed the presence of a potential substance use disorder in students who use substances. Conclusion: Having a family member or peer who uses substance is a risk factor associated with increased likelihood of adolescents in senior school to use substance. These findings could inform culturally sensitive interventions to promote adolescent health and wellbeing in Ghana, and other low-and-middle-income country contexts.背景：物质使用（substance use）在全球范围内对青少年的健康与福祉构成严重威胁，发展中国家的相关检出率持续攀升，引发广泛关注。多项社会心理风险因素（如同伴影响）与保护因素（如自尊水平）均与青少年物质使用行为存在关联。明确当前驱动青少年物质使用的特定社会心理因素，对于制定针对性干预措施至关重要。本研究旨在调查加纳在校青少年的物质使用流行率及其社会心理关联因素。 研究方法：本研究以加纳阿克拉地区的425名高级中学（Senior High School, SHS）学生为随机抽样样本（其中女生242名，平均年龄17.1岁，标准差SD=1.18），开展横断面调查。分别采用罗森伯格自尊量表（Rosenberg Self-esteem Scale）与CAGE-AID物质滥用筛查工具（CAGE-AID substance abuse screening tool）评估受试者的自尊水平与潜在物质使用障碍（substance use disorder）风险。同时对青少年的物质使用相关同伴接触、家庭环境及社交媒体暴露情况进行了评估。研究采用描述性统计方法刻画样本特征，并通过多元逻辑回归模型识别特定物质使用的预测因素。 研究结果：男性学生、与亲属同住的学生以及身边有饮酒同伴的学生，饮酒概率显著更高。在校期间兼职的学生，或家中有吸烟家庭成员的学生，吸烟概率显著升高。年龄较大的学生以及身边有吸食水烟（shisha）同伴的学生，吸食水烟的概率更高。值得注意的是，社交媒体暴露程度较低以及与父母和兄弟姐妹同住的青少年，吸食大麻（marijuana）的概率更低。此外，研究结果显示，存在物质使用行为的学生中存在潜在物质使用障碍的情况。 研究结论：家中有物质使用成员或身边有物质使用同伴，是高中生物质使用概率升高的风险因素。本研究结果可为加纳及其他中低收入国家制定符合当地文化特色的干预措施、促进青少年健康与福祉提供参考依据。