–T ASUNI, O. A. PELA
Health and illness are determined by complex interactions between social and economic factors, the physical environment and individual behaviour. Determinants are a range of factors that influence substance use among individuals or populations. To our knowledge, there is no systematic review that provides an accurate understanding of the determinants of adolescent substance use in Africa. Broadly speaking family, social networks and peer pressure are key influencers of substance abuse among adolescents. For example, several African studies indicate having family or friends who use substances is a key risk factor. Childhood trauma and adverse experience like physical, emotional and sexual abuse is another significant risk factor for substance use. Other demographic and socioeconomic risk factors have included being male, of younger age, lower education grades, adolescents from divorced parents, and unemployed or fully employed mothers in and private school attendance. Some differences have been noted between urban and rural adolescent populations. For urban areas in Nigeria, having friends who use substances and a mother with tertiary education are risk factors whilst parental disapproval of substance use is a protective factor. Adolescent disapproval of adult substance use is a protective factor in rural areas.
Substance use among adolescents is a growing major public health concern in Africa. Unfortunately, this phenomenon has not been adequately documented across many settings in the continent. Knowledge on the true extent and determinants of adolescent substance use in Africa is limited, perhaps due to socioenvironmental factors, competing health priorities and limited treatment options . Moreover, little is known about the relationship between determinants of adolescent substance use in Africa. This is despite the increasing prevalence and increased risks of severe health, economic and social problems due to substance use. Even with the increased need for substance use programmes and policies in Africa highlighted in the Sustainable Development Goals (SDG), there is no consolidated evidence about the social contexts of substance use among adolescents in Africa. Harmful adolescent substance use is not due to any single cause, but a rather complex interaction of risk and protective factors mainly shared with other problematic behaviours like school non-attendance or violence. A conceptual framework for determinants of substance use illustrates this multilevel complexity, by outlining how substance misuse is influenced by an individual’s development, experiences and health, as well as how they interact with their family, their community environment and broader societal-level factors like culture, policy and socioeconomic status . Effectively tackling substance use among young people in Africa where negative outcomes and a complexity of unconventional determining factors for substance use are more common would bring great benefit to human health.
Existing reviews do not provide a detailed holistic and regional understanding of the determinants of substance use among adolescents in sub-Saharan Africa. As previously stated, substance use among adolescents can lead to an increased risk of transmission of sexually transmitted infections, vehicular fatalities, juvenile delinquency and other problems associated with physical and mental health. Adolescents’ increased susceptibility to involvement in substance use can lead to reduced decision-making ability and increased long-term effects of drugs and alcohol.