School-Based Assessment of Substance Use among Adolescents in Rajasthan: Prevalence, Patterns, and Risk Factors

INTRODUCTION

Substance abuse among adolescents is a growing public health concern in India because of its detrimental effects on physical health, academic performance, and psychosocial adjustment. During the transitional period of adolescence, which is characterized by heightened curiosity and sensitivity to peer pressure, teens are more likely to experiment with alcohol, tobacco, and other psychoactive substances.^[1] Recent research from India indicates that social factors, accessibility, and urban exposure all contribute significantly to the onset of substance use at younger ages, often before the age of 15.^[2] Notably, patterns vary by region, with tobacco serving as the main gateway drug in some areas and high rates of alcohol, cannabis, and inhalant use in others.^[3] Socioeconomic status, parental education, family and peer substance use, along with local cultural dynamics, produce diverse risk profiles, even within the same state or community.^[4]

Despite growing awareness, there are very few studies on the prevalence and contributing factors of teen substance abuse in Rajasthan.^[5] Developing interventions at the school level requires early identification of risk and protective factors as well as a better understanding of how and where initiation occurs.^[6,7] The present study was conducted to assess the prevalence and risk factors of substance use among adolescents in Rajasthan.

MATERIAL AND METHODS

RESULTS

Of the 620 participants, 347 (56.0%) were boys and 273 (44.0%) were girls. In Table 1, 90 (14.5%) of the 620 students in school polled said they had used at least one substance, while the majority (85.5%) said they had never used. Eleven point three percent of students reported using tobacco, followed by alcohol (5.6%), and inhalants (3.2%). Boys were more likely than girls to use drugs. Among boys, 22.2% reported using any substance, as compared to 10.0% of girls. This gender difference was statistically significant (odds ratio [OR]: 2.08; 95% confidence interval [CI]: 1.30–3.32; P = 0.002). Tobacco use alone was nearly twice as common among boys (16.7% in government schools, 14.3% in private schools) compared with girls (7.5% in government schools, 5.7% in private schools). Substance use was also influenced by the type of school. The prevalence was higher among students attending government schools (17.1%) than those in private schools (11.4%), and the difference was statistically significant (OR: 1.59; 95% CI: 1.00–2.54; P = 0.048). Overall, boys and government school students constituted the groups at the highest risk for initiation of substance use [Table 1 and Figure 1].

Close

Figure 1:

Prevalence of substance use among youth in Rajasthan. The bar chart illustrates the percentage of participants reporting ever use of tobacco (11.3%), alcohol (5.6%), inhalants (3.2%), and any substance (14.5%).

Export to PPT

Among the 90 students who reported using any substance, the majority initiated the habit during mid-adolescence. In total, 50.0% of users began when they were 14–16 years old, 33.3% when they were 11–13 years old, and 16.7% when they were 17–19 years old. A gender-wise pattern was observed. Among boys (n = 60), initiation peaked at 14–16 years (50.0%), followed by 11–13 years (36.7%), with relatively fewer starting later at 17–19 years (13.3%). Girls (n = 30) showed a slightly different distribution: half initiated use at 14–16 years (50.0%), but a greater proportion than boys reported starting later, at 17–19 years (23.3% vs. 13.3%). Early initiation (11–13 years) was comparatively less common among girls (26.7%) than boys (36.7%). Statistical comparison of initiation age groups between boys and girls did not show a significant difference (χ² = 1.78, P = 0.41). However, the pattern shows that girls tended to start using drugs a little later in adolescence, while boys were more likely to experiment earlier [Table 2].

Determinants of substance use revealed significant associations with peer, family, and socio-demographic factors. Peer influence was the strongest predictor: Students whose friends used substances reported much higher use, with 60 (30.0%) users compared to only 30 (7.5%) among those without such peers. This association was highly significant (OR: 5.57; 95% CI: 3.45–8.99; P < 0.001). Parental and sibling habits also showed important effects. Substance use was more frequent among students whose fathers used substances, 50 (20.0%), compared with 40 (10.8%) where fathers did not (OR: 2.06; 95% CI: 1.31–3.24; P = 0.001). Similarly, 25 (25.0%) of the students with siblings who used substances reported use, compared with 65 (11.7%) among those without (OR: 2.33; 95% CI: 1.38–3.93; P = 0.001). Maternal substance use showed a higher proportion, 12 (20.0%) versus 78 (13.5%), but this difference was not statistically significant (P = 0.205). Socio-demographic characteristics also played a role. Students from government schools had a higher prevalence, 58 (17.1%) compared to 32 (11.4%) students in private schools (OR: 1.59; 95% CI: 1.00–2.54; P = 0.048). Lower parental education was associated with greater substance use: 70 (16.7%) students among those with non-graduate fathers compared to 20 (9.5%) with graduate fathers (P = 0.028), and 72 (16.4%) among those with non-graduate mothers versus 18 (10.0%) with graduate mothers (P = 0.041). Father’s blue-collar occupation, 55 (18.3%) versus 35 (10.9%) in white-collar (P = 0.009), and maternal employment, 35 (19.4%) versus 55 (12.5%) in homemakers (P = 0.026), were also significant correlates [Table 2].

DISCUSSION

The present study, which involved 620 school-age adolescents in Rajasthan between the ages of 10 and 19, the overall prevalence of substance use was 14.5%. The most common substance used was tobacco (11.3%), followed by alcohol (5.6%), and inhalants (3.2%). With almost one-third beginning between the ages of 11 and 13 and half between the ages of 14 and 16, the age of initiation was concentrated in early adolescence. Significant predictors included male gender, attendance at government schools, family history, peer substance use, and lower parental education. These results highlight important patterns of initiation and risk factors of substance use among adolescents and are consistent with the evidence currently available from India. Identical results have been reported in various Indian states. Pandya et al.^[9] conducted their study among adolescents aged 13–19 years in the tribal sub-plan area of Rajasthan, which is comparable to the present study population. He reported a prevalence of 12.3%, with tobacco being the most common substance and peer influence being the main risk factor.

Similarly, Semwal et al.^[10] in Dehradun observed that both adolescents and young adults (10–24 years) reported substance use at significant levels, with peer pressure, family influences, and stress being dominant correlates. These convergent results imply that the risk environment and determinants are remarkably consistent, even though prevalence estimates may differ slightly between regions. A significant percentage of substance users in India start using drugs before the age of 20, according to national-level data from the Ministry of Social Justice and Empowerment. This is consistent with our finding that initiation typically takes place in early to mid-adolescence.^[11] The Delhi school-based study by Batra et al.^[7] was conducted among students aged 12–18 years, like the current sample. The prevalence of ever-use was 16.8%, with alcohol and tobacco ranking highest. This study showed a consistent pattern of early initiation across urban schools. These results support the idea that prevention measures should start before the age of 14, and that adolescence is a crucial time for intervention.

Risk factor analysis in our study demonstrated that peer influence was the strongest determinant (OR 5.57), a finding echoed by other school-based research. The Delhi school survey found that students whose friends used substances were nearly four times more likely to engage in similar behavior.^[7,12] Similarly, Semwal et al.^[10] also found peer use to be a strong predictor of substance involvement among adolescents in Uttarakhand. Family environment also emerged as a crucial determinant in our study, with paternal and sibling substance use significantly increasing risk – consistent with the Rajasthan tribal-area survey, where family exposure to tobacco and alcohol strongly influenced adolescent initiation.^[9] This pattern is supported by broader national surveys, which show that intergenerational use is widespread and that teenagers frequently imitate behaviors they see at home.^[11] Additionally, parental education level and school type were found to be significant predictors in our study. Adolescents in government schools and those with non-graduate parents were more likely to use substances. This aligns with the multicentric study by Venkatesh et al.,^[1]which documented that lower parental education and socioeconomic disadvantage were associated with higher substance use among adolescents attending primary health centers. Similarly, Das et al.^[13] in coastal Karnataka found that poor awareness and more permissive environments among families of college students were linked to increased experimentation. Taken together, these studies highlight that substance use in Indian adolescents is not an isolated behavioral problem but one embedded within broader social, familial, and educational contexts.

Limitation

The cross-sectional design of this study limits causal inference between risk factors and substance use. Reliance on self-reported data may have introduced recall and social desirability bias, particularly leading to underreporting among adolescents. As the study was school-based, out-of-school adolescents were not included, possibly resulting in an underestimation of prevalence. In addition, the study did not distinguish between daily and occasional (binge) substance use, which limits detailed assessment of use patterns.

CONCLUSION

This study highlights that substance use among school-going adolescents in Rajasthan is a growing concern, with tobacco being the most common substance and initiation often beginning as early as 11–13 years. Peer influence, family history, and lower parental education were strong contributors, while students in government schools were found to be more vulnerable. These findings point to the urgent need for preventive efforts that go beyond classroom awareness, including early interventions, peer-led programs, and active parental involvement. Strengthening school-based health initiatives, while limiting the availability of substances near schools, can help reduce the burden. Addressing these well-established risk factors – such as peer and family influence – through early preventive programs is key to protecting the health and future of adolescents.