ArticleBMJ paediatrics open2026
Patterns and risk factors of illicit substance abuse by Sri Lankan teenagers: a case-control study.
Article in BMJ paediatrics open, 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
backgroundIllicit substance abuse among adolescents is an emerging public health challenge in Sri Lanka, yet evidence on independent risk factors, particularly among high-risk teenagers undergoing rehabilitation, remains limited. Understanding social, familial, peer and school-related determinants is essential to inform targeted prevention and intervention strategies.
methodsA case-control study was conducted among adolescents aged 10-17 years. Cases (n=108) were teenagers admitted for inpatient rehabilitation for illicit substance abuse at the Youth Drug Addiction Prevention, Treatment and Rehabilitation Centre, Kandy, Sri Lanka. Age-matched and sex-matched controls were recruited from the outpatient department of North Colombo Teaching Hospital, Ragama. Data were collected using a structured questionnaire assessing individual, peer, family, school and psychosocial factors. Associations were examined using χ² tests, and independent risk factors were identified using multivariable logistic regression. Statistical significance was set at p<0.05.
resultsPeer-related factors showed the strongest associations with substance abuse. Peer use of illicit substances (adjusted OR 32.16; p<0.001) and peer encouragement of substance use (adjusted OR 14.26; p<0.001) were the most powerful independent predictors. Other significant independent risk factors included association with antisocial peer groups (adjusted OR 10.4; p<0.001), parental separation (adjusted OR 5.34; p<0.001), perceived school neglect (adjusted OR 3.14; p<0.001), problematic social media use (adjusted OR 2.52; p=0.002) and perception of substance use as a means of gaining social popularity (adjusted OR 2.44; p=0.004). A high burden of psychological vulnerability was observed, with 46.3% reporting prior self-harm-related thoughts.
conclusionsIllicit substance abuse among Sri Lankan teenagers is predominantly driven by peer influence, family disruption, school disengagement and social vulnerabilities. Prevention and intervention strategies should prioritise peer-focused approaches, family strengthening, school re-engagement and integrated mental health support.
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