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.