A new study has found that being male and having friends who use substances are the strongest predictors of substance use among teenagers in Africa. The findings were published in the journal Addiction.
The systematic review and meta-analysis, conducted by researchers from Millennium University in Malawi and Queen Mary University of London, analysed data from 63 studies across the continent. It provides the most comprehensive insight to date into what drives young people aged 10 to 19 to use substances such as alcohol, tobacco and cannabis.
The findings reveal that teenage boys are significantly more likely to engage in substance use than girls. The study’s meta-analysis showed that boys had almost twice the odds of being current smokers compared to girls, while the presence of peers who smoke increased the risk of smoking by nearly fivefold.
Researchers noted that the social environment plays a major role. In addition to peer influence, teenagers who live with family members who smoke or drink are also more likely to use substances themselves. The study found that having a parent or guardian who smokes nearly triples the likelihood of a teenager starting to smoke.
Older adolescents are also more at risk, suggesting that substance use tends to increase with age during the teenage years. Mental health problems, such as depression and suicidal thoughts, were frequently linked to substance use, further highlighting the emotional and psychological vulnerabilities of this age group.
The study’s lead authors emphasised that these behaviours are not just shaped by individual choices but are deeply embedded in the wider social and cultural landscape. Factors such as lack of parental supervision, poor school attendance, exposure to violence and aggressive advertising by alcohol and tobacco industries were also cited as contributors.
In some cases, economic factors played a role. For example, teenagers from wealthier backgrounds who received higher amounts of pocket money were more likely to be smokers, particularly in rural schools. Conversely, low socio-economic status was linked to increased alcohol use in urban settings, suggesting that the context of wealth and poverty influences substance use in different ways depending on location.
Despite the rising rates of substance use, there is a significant gap in support and intervention services. Most of the included studies were based on school-going teenagers, with fewer data available on more vulnerable groups such as homeless or HIV-positive youths. This limits the scope of current understanding and interventions.
The research team called for more targeted public health strategies to address this growing problem. They suggested that prevention programmes should be both age-sensitive and gender-specific, with greater emphasis on tackling peer influence and improving family dynamics. Interventions must also be tailored to the cultural and regional realities of different African countries, where resources and infrastructure for youth mental health and substance misuse services are often limited.
They also urged governments and communities to take a more active role in protecting teenagers from harmful influences, particularly by regulating advertising and investing in mental health education in schools.
As substance use among teenagers rises, the study’s authors warned that failing to act now could have lasting consequences for public health across the continent.
