Early Substance Use Initiation And Psychological Distress Among Adolescents In Five ASEAN Countries: A Cross-Sectional Study

AIM: The study aimed to assess the associations between substance use early initiation (<12 years) (smoking cigarettes, alcohol and drug use) with psychological distress among adolescents in five ASEAN countries. METHODS: Cross-sectional data were analysed from 33,184 school adolescents, with a median age of 14 years, from Indonesia, Laos, Philippines, Thailand and Timor-Leste that took part in the “Global School-Based Student Health Survey (GSHS)” in 2015. RESULTS: The overall prevalence of pre-adolescent (<12 years) cigarette use was 10.6%, 8.1% pre-adolescent current alcohol use, and 4.2% pre-adolescent drug use initiation. In adjusted multinomial logistic regression analysis, pre-adolescent initiation of cigarette smoking, pre-adolescent initiation of alcohol use, pre-adolescent initiation of drug use and multi-substance pre-adolescent initiation were highly associated with medium (=1) and high (=2–5) psychological distress (of five psychological distress items: no close friends, loneliness, anxiety, suicidal ideation and suicide attempt). Late initiation of cigarette use and late initiation of drug use were not associated with medium and/or high psychological distress. CONCLUSION: Early prevention programmes should target concurrent early substance use initiation in order to prevent possible subsequent psychological distress.