Cannabis and tobacco use among adolescents aged 12-17 years from 16 low- and middle-income countries

BACKGROUND: We aimed to examine the association between cannabis use and tobacco use in 12-17-year-old adolescents residing in low- and middle-income countries (LMICs). METHODS: We used data from the Global School-based Student Health Survey collected between 2012 and 2022. We selected 16 LMICs based on pre-defined inclusion criteria and compared the prevalence of cannabis use for female and for male adolescents for each country. We estimated age- and sex-standardised distributions of tobacco use, school truancy, suicide attempt, sex with multiple partners, physical fighting, perceived school kindness, and parental monitoring were estimated. We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) measuring associations between cannabis use and other variables. We generated pooled estimates through random effects meta-analyses. RESULTS: The overall pooled prevalence of cannabis use was 4.3% (95% CI = 3.2-5.9), with significant between-country heterogeneities (I(2) = 91.4%; P = 0.000). Cannabis use was more prevalent in males than in females in each country. Tobacco use was strongly associated with cannabis use in all 16 LMICs. Tobacco users had approximately 11 to 14 times greater odds of cannabis use than non-tobacco users. Sex with multiple partners, suicide attempts, and school truancy had a robust association with cannabis use in over half of LMICs. CONCLUSIONS: There is a need for comprehensive preventive measures targeting multiple risk behaviours associated with cannabis use for adolescents in LMICs.