Abstract
Background: Preventing suicide among adolescents is an urgent global public-health challenge, especially in Africa. Accordingly, the aim of this study was to examine the relationship between the early initiation (< 12 years old) of substance use (cigarette smoking, alcohol use, and drug use) and attempted suicide among in-school adolescents in seven African countries.Methods: Data on the early initiation of substance use and on attempted suicide among in-school adolescents over the previous 12 months in Benin, Liberia, Mauritius, Mozambique, Namibia, Seychelles, and the United Republic of Tanzania were collected from Global School-based Student Health Surveys and were pooled to determine the overall prevalence of these behaviors in adolescents. Univariate and multivariate logistic regressions were then performed to evaluate country-specific associations between the early initiation of substance use and attempted suicide in these adolescents, followed by meta-analyses to evaluate overall pooled associations.Results: In the abovementioned seven African low- or middle-income countries (LMICs), overall weighted prevalences of attempted suicide and early initiation of cigarette smoking, alcohol use, and drug use among in-school adolescents were 16.05, 7.76, 17.68, and 3.48%, respectively. Multivariate logistic regression analyses revealed that relative to non-smoking, the early initiation of smoking was significantly associated with attempted suicide in these adolescents [OR (95% CI) = 1.783 (1.219–2.348)]. Additionally, the relationship between early initiation of cigarette smoking and attempted suicide is mostly driven by a higher association in girls [OR (95% CI) = 1.867 (1.031–2.703)] than boys [OR (95% CI) = 1.392 (0.995−1.789)]. Moreover, relative to not using other drugs, the early and later initiation of other drug use were also significantly associated with attempted suicide in these adolescents [ORs (95% CIs) = 2.455 (1.701–3.208) and 1.548 (1.198–1.898)].Conclusion: Programs that can eliminate or decrease the early initiation of substance use among adolescents should be implemented in African LMICs to prevent subsequent suicide attempts, especially among adolescent girls.
Highlights
The prevention of adolescent suicide is an urgent global public-health challenge (Arensman et al, 2020)
The data used for this study were obtained from the publicly available datasets of the Global School-based Student Health Survey (GSHS), which is a self-administered, school-based multicountry survey that has been conducted in low- and middleincome countries (LMICs) and was jointly developed by the World Health Organization (WHO) and the United States Centers for Diseases Control and Prevention (CDC) (Xi et al, 2016; Campisi et al, 2020)
The prevalences of the early initiation of cigarette smoking and other drug use in African adolescents were 7.8 and 3.5%, respectively, which was less than the prevalences that have been reported in previous studies of adolescents in Pacific Island countries (15.7 and 12.9%) (Peltzer and Pengpid, 2015), SouthEast Asian nations (10.6 and 4.2%) (Pengpid and Peltzer, 2019), France (24.1 and 3.9%), and the United States (18.1 and 9.7%) (Swahn et al, 2012a)
Summary
The prevention of adolescent suicide is an urgent global public-health challenge (Arensman et al, 2020). In 2016, more than 62,000 adolescents worldwide died by suicide, with more than 90% of these deaths occurring in low- and middleincome countries (LMICs) (World Health Organization, 2020). It is vital to clarify the factors associated with suicide attempts. This is in keeping with the United Nations Sustainable Development Goals (SDGs) Indicator 3.4.2, which emphasizes reducing the suicide mortality rate as one of the ways to reduce premature mortality from non-communicable diseases by one-third by 2030 (United Nation, 2020). Preventing suicide among adolescents is an urgent global public-health challenge, especially in Africa. The aim of this study was to examine the relationship between the early initiation (< 12 years old) of substance use (cigarette smoking, alcohol use, and drug use) and attempted suicide among in-school adolescents in seven African countries
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