Adolescents Risk Factors for Problem Behaviour in Mumbai, India: A Cross National Comparison with Australia and United States.

Introduction: India has the largest population of adolescents in the world. With rapid modernisation and globalisation progressing in India, it is important to investigate whether adolescent problem behaviours such as alcohol, tobacco and other drug use have comparable associations and determinants to countries such as the United States of America (U.S.) and Australia that have active prevention research programs. This study aims to determine whether or not students in these three nations report similar problem behaviours, and whether similar risk factors are predictive of the development of these behaviours. Methods: A two-stage cluster sample design was used to select student classroom samples. Firstly schools were stratified into government and non-government categories. Schools were then randomly sampled in each category. The study recruited by randomly sampling Mumbai schools with students in Grades 5, 7 and 9. The Mumbai sample was 4,770 students. The sampling methods, survey procedures and instruments were matched to enable cross-national comparison with same-aged student cohorts that have been surveyed as matched cohorts in Victoria, Australia (N = 2,864) and Washington State, US, (N = 2,866). A survey instrument known as the International Youth Development Study (IYDS) was used in all three nations. Results: The approximate mean age of respondents in three States was 13 years. There were significantly fewer females in the Mumbai sample (45%, 95CI 43-48), compared to the Melbourne (52%, 95CI 49-56) and Seattle/Tacoma sample (51%, 95CI 49-53). The findings reveal lower rates of alcohol use for students in the three grades in Mumbai, lower tobacco and illicit drug use in grades 7 and 9, but similar rates of tobacco and illicit drug use in grade 5. The prevalence of risk factor scores were similar in Mumbai relative to the comparison nations, although associations were generally weaker in Mumbai. Conclusions: This three nations study contributes preliminary evidence regarding differences in effects of demand reduction, harm minimization and abstinence norms and policies on adolescent substance-use. The finding that the prevalence of many of the predictors of adolescent problem behaviour are similar in Mumbai in comparison to Victoria and Washington State has implications for the implementation in India of prevention and early intervention programs developed in US and Australia to address the common risk and protective factors. The US and Australian programs that address common predictors and have been tested and found to be effective in reducing problem behaviours may be appropriate in the Indian context.