Correlates of Substance Use in Male Pakistani Adolescents: The Roles of Demographics, Substance Use By Family and Friends, and Mental Health Symptoms

Title: Correlates of Substance Use in Male Pakistani Adolescents: The Roles of Demographics, Substance Use by Family and Friends, and Mental Health Symptoms

Substance use is a significant problem in Pakistan, particularly among male adolescents, yet there are few studies of the correlates of use in this population. As a first step in the prevention cycle, the objective of present study was to determine the prevalence and significant correlates of substance use and abuse in a sample of male Pakistani adolescents. Male secondary school students (N = 243; M = 16.9 years, SD = 1.3 years; Range = 12 to 18) were recruited from private sector secondary schools in Karachi.Students completed demographic information (e.g., birth order, number of siblings, age, education level, family structure, household income), questions on substance use by family and friends, the Pediatric Symptom Checklist (PSC; Jellinek, Murphy, Robinson, Feins, Lamb, & Fenton, 1988),the Alcohol Use Identification Test (AUDIT; WHO; 2001), and questions about lifetime use of tobacco, alcohol, and hashish.Regression analyses were used to evaluate the contributions of demographic factors, substance use by family and friends, and mental health symptoms to adolescent substance use and abuse. Lifetime use of substances ranged from 21% (Hashish) to 45% (Alcohol). Fortyone percent of respondents reported ever smoking cigarettes. Over one-fifth of the sample (22.60%) fell into the highest risk group on the AUDIT, indicating the need for intervention. Multivariate analyses included demographic correlates, family and friend substance use, and internalizing, externalizing, and attentional problem subscales from the PSC. Results varied by outcome. With lifetime cigarette use as the outcome, internalizing (OR = 1.26; CI = 1.00 to 1.58) and attentional problems (OR = 1.57;CI = 1.26 to 1.97)were significant correlates. With lifetime hashish use as the outcome, living in a joint family structure with extended family – which was true for 53% of the sample -- was associated with a lower likelihood of lifetime hashish use and the only significant correlate (OR = .33; CI= .15 to .75). Lifetime alcohol use was associated with several factors. Higher numbers of siblings was associated with a lower likelihood of lifetime alcohol use (OR = .56; CI= .35 to .89), drug use by friends (OR = 4.41; CI = 1.19 to 16.41); internalizing problems (OR = 1.85; CI = 1.32 to 2.59) and attentional problems (OR = 2.15, CI = 1.50 to 3.06) was associated with greater likelihood of alcohol use. Problematic alcohol use, as indicated by extreme scores on the AUDIT, was associated with drug use by family members (OR = 2.80; CI = 1.18 to 6.62), attentional problems (OR = 1.59; CI = 1.22 to 2.07), and externalizing problems (OR = 1.28; CI = 1.02 to 1.59). Implications for the prevention of problematic substance use is discussed.