Prevalence and factors associated with alcohol and substance use among secondary school adolescents in central and Eastern Uganda: a cross-sectional study. BMC Public Health 2025 Dec 15;26(1):252
Date
12/16/2025Pubmed ID
41398236Pubmed Central ID
PMC12821920DOI
10.1186/s12889-025-25944-7Scopus ID
2-s2.0-105027965729 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: Alcohol and substance use is a major public health concern in Uganda, with limited evidence focused on school-going adolescents. This study determined the prevalence and factors associated with alcohol and substance use among adolescents in secondary schools in Central and Eastern Uganda.
METHODS: This cross-sectional study surveyed 1,833 adolescents aged 10-18 years from eight randomly selected secondary schools in Iganga (Eastern) and Mukono (Central) districts. Schools were stratified by ownership (private or public), and geographic setting (eastern or central). We used the Child and Adolescent Symptom Inventory-5 (CASI-5) to assess the primary outcomes: significant use of alcohol, tobacco, marijuana, and impairment from any substance use. Logistic regression models determined the factors independently associated with significant use of alcohol, tobacco, marijuana and impairment from any substance use. Adjusted odds ratios (AOR) and corresponding 95% confidence intervals (95%CI) were reported.
RESULTS: Among 1,833 school-going adolescents, the mean age was 15.1 years (SD ± 1.6), 60% were female, and 50.7% attended urban schools. The prevalence of significant use was 1.7% (n = 30) for tobacco, 3.0% (n = 54) for alcohol, 2.6% (n = 46) for marijuana, and 6.2% (n = 105) reported significant impairment from any substance use. In adjusted analyses, male adolescents had higher odds of marijuana use than females (AOR 2.21, 95%CI 1.17-4.19, p = 0.015). A history of mental illness was associated with higher odds of marijuana use (AOR 2.87, 95%CI 1.45-5.67, p = 0.002), alcohol use (AOR 2.69, 95%CI 1.42-5.09, p = 0.002), and SUD impairment (AOR 1.91, 95%CI 1.14-3.18, p = 0.014) compared to those with no such history. Urban school attendees had higher odds of SUD impairment than rural attendees (AOR 2.37, 95%CI 1.47-3.81, p < 0.001), and adolescents living in huts had higher odds of tobacco use than those in permanent housing (AOR 5.46, 95%CI 1.12-26.59, p = 0.036).
CONCLUSIONS: Targeted school-based interventions addressing sex-specific risks, and urban-rural disparities in mental health may help reduce use of alcohol, substances and SUD impairment among adolescent students in central and eastern Uganda.
Author List
Bing W, Abbo C, Dickson-Gomez J, Kiconco A, Odokonyero FR, Bobholz M, Shour AR, Kasasa S, Kabanda R, Kalani K, Cassidy LD, Anguzu RAuthors
Ronald Anguzu PhD, MD Assistant Professor in the Institute for Health and Humanity department at Medical College of WisconsinLaura Cassidy PhD Associate Dean, Institute Director, Professor in the Institute for Health and Humanity department at Medical College of Wisconsin
Julia Dickson-Gomez PhD Professor in the Institute for Health and Humanity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAlcohol Drinking
Child
Cross-Sectional Studies
Female
Humans
Male
Prevalence
Risk Factors
Schools
Students
Substance-Related Disorders
Uganda
