ArticleThe Lancet regional health. Southeast Asia2026
Substance use risk among school going adolescents in India: secondary analysis of Community Based Peer-Led Intervention (CPLI) trial.
Article in The Lancet regional health. Southeast Asia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Adolescent substance use is an increasing public health concern in India, yet multicentre studies are limited. In this study we aimed to understand variation in substance use risk across multiple schools in selected districts of India. Methods: This study utilised cross-sectional baseline data from a multi-centre cluster randomised trial on peer-led intervention to reduce substance use, it included 6168 adolescents from 108 schools across six Indian districts (2025-2026). Substance use risk was assessed through self-reporting of participants using the WHO Alcohol, Smoking and Substance Involvement Screening Test and personality traits were assessed using the Substance Use Risk Profile Scale (SURPS). Determinants were examined using three-level multilevel ordinal logistic regression models accounting for clustering at school levels. Inter-district disparities were investigated using Fairlie decomposition. Findings: Highest substance use risk was observed in selected schools of Guwahati and lowest in Nagpur and Puducherry. Higher accessibility to substances (high: aOR 1.75, 95% CI: 1.36-2.26), high digital exposure (aOR 1.44, 95% CI: 1.16-1.79), and favourable attitudes towards substance use (aOR 1.30, 95% CI: 1.01-1.69) were associated with increased risk, whereas male adolescents had lower odds than females (aOR 0.74, 95% CI: 0.62-0.88). The Guwahati-Nagpur prevalence gap was 35.1 percentage points, of which 37.9% was explained by observed characteristics, mainly school characteristics, socio-demographic and economic factors, and personality traits. Interpretation: Substance use risk among adolescents in India varies substantially across settings. Context-specific strategies targeting digital exposure, and local environments may help reduce inequalities in substance use risk. Funding: This study is supported by Indian Council of Medical Research, Extramural Research Grant (2024-01-00480).
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