Oppong Asante Child Adolesc Psychiatry Ment Health (2019) 13:33 Child and Adolescent Psychiatry https://doi.org/10.1186/s13034-019-0293-0 and Mental Health RESEARCH ARTICLE Open Access Cannabis and amphetamine use and its psychosocial correlates among school-going adolescents in Ghana Kwaku Oppong Asante1,2,3* Abstract Background: The aim of this study was to examine the prevalence of cannabis and amphetamine use and to deter- mine its associated factors among school-going adolescents in Ghana. Method: The 2012 Ghanaian Global School-based Student Health Survey on 3632 adolescents aged 11–19 years (mean = 15.1 years; SD = 1.4) was used. Participants for this study were sampled from selected junior (JHS) and senior high schools (SHS) in all the 10 administrative regions of Ghana. A two-stage cluster sampling design was used to select 25 senior high schools to represent all the 10 regions of Ghana. Information was collected with a self-admin- istered structured questionnaire that contained information on demographics, alcohol, tobacco and other drug use, violence, and a range of other health-related behaviours. Results: The result showed that past-month cannabis use was 5.3% and lifetime amphetamine use was 7.1% among students. In multivariate model, after controlling for other variables, school truancy and current cigarette smoking were associated with both past-month cannabis and lifetime amphetamine use. The number of close friends was associated with only past-month cannabis use. School environment factors (bullying victimisation and having been attacked) and parental substance use were associated with lifetime amphetamine use. Conclusion: This study identified a number of risk factors, including parental substance use and various risk behav- iours, for both past-month cannabis and lifetime amphetamine use. School-based health intervention programmes should be developed taking into consideration the risk factors associated with cannabis and amphetamine use among school-going adolescents. Keywords: School-going adolescents, Amphetamine use, Cannabis use, Risk factors, Ghana Introduction stimulants, cocaine, and opioids were the most com- Illicit drug use contributes significantly to the global bur- monly used illicit drugs [3]. den of disease, and thus is considered an emerging public In a South African population-based survey conducted health problem [1, 2]. According to the United Nations among individuals aged 12 years and older in 2012, past Office on Drugs and Crime (UNODC), the global preva- 3-month prevalence of illicit drug use was 4.4% [4]. A lence of illicit drug use (including amphetamines, canna- Ghanaian population-based national study conducted in bis, cocaine, opioids, etc.) in 2015 was 5.3% [3]. The same 2008 among school-going adolescents, found the preva- report also indicated that cannabis, amphetamine-type lence of past 1-month (any) drug use to be 3.6% [5]. Earlier follow-up studies among adolescents in Ghana reported prevalence rates of 2.6% and 7.2% for past- month cannabis use [6, 7]. *Correspondence: kwappong@gmail.com; koppongasante@ug.edu.gh Previous studies have established that specific sociode- 1 Department of Psychology, University of Ghana, P. O. Box LG 84, Legon, Accra, Ghana mographic factors are associated with both cannabis and Full list of author information is available at the end of the article amphetamine use, including male gender [5, 8] and older © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creati veco mmons .org/licen ses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Oppong Asante Child Adolesc Psychiatry Ment Health (2019) 13:33 Page 2 of 9 age [5, 6]. Furthermore, certain mental health-related be at risk for regular cannabis and lifetime amphetamine behaviours such as anxiety [9, 10], loneliness [8], sui- use. cidal behaviour [11] and health risk behaviours including sexual risk behaviours [8, 12, 13], and current smoking Methods [8, 14] have been found to be associated with ampheta- Participants and procedure mine and cannabis use. The literature has shown inter- Data for this study were obtained from the Ghana Global personal factors within the school environment to be School-based Student Health Survey (GSHS) conducted related to amphetamine and cannabis use: being bullied in 2012 [21]. This survey was conducted through a part- [13, 15], physical fighting and being physically attacked nership between the World Health Organization (WHO), [15], school truancy [14–16], lack of peer support [14], the Center for Disease Control and Prevention (CDC), having a greater number of friends [17, 18] and hunger Middle Tennessee State University and the Ghana Educa- [8]. In addition, parental attributes such as parental sub- tion Service (GES). The data were collected using a cross- stance use [9, 19], lack of parental support and monitor- sectional survey design among WHO countries which ing [14], lack of parental connectedness [9] and lack of were interested in examining the behavioural risk factors maternal demandingness [8] have been shown to influ- and protective factors in several domains of functioning ence amphetamine and/or cannabis use among school- among school-going adolescents. Data were collected going adolescents. through the use of close-ended structured questionnaires Within the Ghanaian context, no study has explored administered to the students. The GES’s policies on eth- factors related to past-month cannabis and lifetime ics regarding the use of students in survey studies were amphetamine use among school-going adolescents. Pre- adhered to in the data collection. Written informed con- vious studies have predominantly focused on substance sent was obtained from students aged 18 years and above, use (particularly tobacco and alcohol use) and its asso- while parental consent was taken for students who were ciated factors [6, 19, 20]. For example, Doku et  al. [6] less than 18 years prior to their participation in the study. reported elevated levels of alcohol use and further indi- As stipulated by GSHS, participation in the study was cated that alcohol use among school-going adolescents voluntary, anonymous, and confidential. The response was associated with higher material affluence. Similarly, rate was 74%. in their examination of the relationship between fam- ily dynamics and students’ alcohol use, Asiseh et al. [19] Sampling procedure revealed that parental alcohol use increased the odds of Participants were sampled from selected junior (JHS) and the adolescents’ alcohol use irrespective of gender. senior high schools (SHS) in all 10 administrative regions However, we are not well informed about the factors of Ghana. A two-stage cluster sampling design was used associated with cannabis and lifetime amphetamine use to select 25 senior high schools to represent all 10 regions among school-going adolescents in Ghana. Additionally, of Ghana. Selection of schools at the first stage of sam- since culture substantially influences human behaviour, pling was based on a probability proportional to size of the determinants of substance use as reported in devel- enrollment. At the second stage, a random sampling oped Western countries (lack of parental support and technique was used to select the classes in each school. monitoring, anxiety, loneliness, peer support, and sexual This allowed every student to have an equal chance of risk behaviours) [10, 14, 16] may not be applicable to high being selected for the study. Numerical weights were school students in Ghana. applied to each student record to enable generalization In order to adapt interventions for illicit drug use of results to the eligible population. The students were among school-going adolescents in Ghana, national pop- relatively equally split across the four senior high school ulation-based prevalence data on cannabis and amphet- grade levels. amine use are needed. Therefore, the purpose of this secondary analysis is to estimate the prevalence of can- Measures nabis and amphetamine use and its associated factors The Ghana Global School-based Student Health Survey among school-going adolescents using a nationally rep- (GSHS) utilised a questionnaire that contained informa- resentative school-based survey conducted in 2012. This tion on demographics, alcohol, tobacco, and other drug study focused on past-month cannabis use and lifetime use, violence, and a range of other health-related behav- amphetamine use because regular cannabis use is more iors [21, 22]. The Ghanaian version of the Global Student common among this population than regular ampheta- Health Survey was piloted and found to be culturally mine use [1–3]. The findings of this study could inform appropriate for use within Ghana [5]. The variables used interventions that target high school students who may in this study are described in Table 1. Oppong Asante Child Adolesc Psychiatry Ment Health (2019) 13:33 Page 3 of 9 Table 1 Independent variables derivation from survey data Variable Survey question Original response options Recoded Age How old are you? 11–18 years (coded categorically) N/A Sex What is your sex 1 = male; 0 = female N/A Anxiety During the past 12 months, how often have you 1 = never to 5 = always 1–3 = 0 and 4–5 = 1 been so worried about something that you could not sleep at night? Loneliness During the past 12 months, how often have you 1 = never to 5 = always 1–3 = 0 and 4–5 = 1 felt lonely? Suicidal Ideation During the past 12 months, did you ever seri- Yes = 1; no = 2 Yes = 1 and no = 0 ously consider attempting suicide? Suicidal plan During the past 12 months, did you make a plan Yes = 1; no = 2 Yes = 1 and no = 0 about how you would attempt suicide? Suicidal attempt During the past 12 months, how many times, 1 = 0 times to 5 = 6 times or more 1 = 0 and 2–5 = 1 did you actually attempted suicide School truancy During the past 30 days, how many days did 1 = 0 days to 5 = 10 or more days 1 = 0 and 2–5 = 1 you miss classes or school without permis- sion? Bullied During the past 30 days, how many days were 1 = 0 days to 7 = all 30 days 1–3 = 0 and 4–7 = 1 you bullied? Physically attacked During the past 12 months, how many times 1 = 0 times to 8 = 12 or more times 1 = 0 and 2–8 = 1 were you physically attack? In a physical fight During the past 12 months, how many times 1 = 0 times to 8 = 12 or more times 1 = 0 and 2–8 = 1 were you in a physical fight? Hunger During the past 30 days, how often did you go 1 = never to 5 = always 1–3 = 0 and 4–5 = 1 hungry because there was not enough food in your home? Sexual risk behaviour During your life, with how many people have 1 = never had intercourse to 7 = 6 or more 1 = 0 and 2–7 = 1 you ever had sexual intercourse people Close friends How many close friends do you have? 1 = 0 friends to 4 = 3 or more close friend 1 = 0 and 2–4 = 1 Peer support During the past 30 days, how often were most 1 = never to 5 = always 1–3 = 0 and 4–5 = 1 of the students in your class kind and helpful? Current smoking of cigarette During the past 30 days, how many days did 1 = 0 days to 7 = all 30 days 1 = 0 and 2–7 = 1 you smoke cigarette? Parental tobacco use Which of your parents or guardian use any form 1 = never to 4 = both 1 = 0 and 2–4 = 1 of tobacco? Parental monitoring During the past 30 days, how often did your 1 = never to 5 = always 1–3 = 0 and 4–5 = 1 parents or guardians check to see if your homework was done? Parental understanding During the past 30 days, how often did your 1 = never to 5 = always 1–3 = 0 and 4–5 = 1 parents or guardians understand your prob- lems and worries? Parental bonding During the past 30 days, how often did your 1 = never to 5 = always 1–3 = 0 and 4–5 = 1 parents or guardians really know what you were doing you’re your free time? Parental intrusion of privacy During the past 30 days, how often did your 1 = never to 5 = always 1–3 = 0 and 4–5 = 1 parents or guardians go through your things without your approval? Cannabis use During the past 30 days, how many times have 1 = 0 days to 5 = All 30 days 1 = 0 and 2–5 = 1 you used marijuana (also called weed, Jah, Indian hemp, ahabammmono, and ganja)?” Amphetamine During your life, how many times have you used 1 = 0 times to 5 = 20 or more times 1 = 0 and 2–5 = 1 amphetamine or methamphetamine (also called ice or yellow) Data analysis population, and further to reduce bias on the differing Sample weights were applied in all analyses to reduce pattern of non-response. All variables were re-coded on a bias from non-response, improve generalisability to the dichotomous scale as in other existing GSHS studies [11, Oppong Asante Child Adolesc Psychiatry Ment Health (2019) 13:33 Page 4 of 9 12, 19, 20]. The primary analyses were performed in two understanding of adolescents was only associated with steps to determine factors most strongly associated with past-month cannabis use. cannabis and lifetime amphetamine use in adolescents. First, bivariate analyses using the Chi-square (χ2) test Predictors of cannabis and amphetamine use were used to examine possible associations between the among school‑going adolescents explanatory variables and past-month cannabis and life- The predictors of both past-month cannabis use, and life- time amphetamine use. In the second step, Multinomial time amphetamine use are presented in Table 3. In mul- logistic regression analyses were conducted to examine tivariate analysis, after controlling for other variables, the independent predictors of substance use. The results school truancy (OR = 3.34; 95% CI = 1.88–5.92; p < 0.001) from the regression analyses are presented as odds ratios and current smoking (OR = 12.48; 95% CI = 6.48–24.02; (OR) with 95% confidence intervals (CI). Statistical sig- p < 0.001) were associated with past-month cannabis use. nificance was defined as two-tailed p-value < 0.05 in all A greater number of close friends was positively associ- analyses. The Statistical Package for the Social Sciences ated with only past-month cannabis use (OR = 2.37; 95% (SPSS) version 23.0 was used to conduct data analyses. CI = 1.19–4.71; p < 0.05). The results further showed in adjusted analysis that school truancy (OR = 1.74; 95% Results CI = 1.13–2.68; p < 0.05), current smoking (OR = 4.74; Sample characteristics 95% CI = 2.50–9.00; p < 0.001), school environment fac- A total of 3632 school-going adolescents aged tors such as bullying victimisation (OR = 2.09; 95% 11–19  (mean = 15.1  years; SD = 1.4) participated in CI = 1.27–3.43; p < 0.01) and having been attacked the study. This sample included 1932 (53.2%) males (OR = 2.16; 95% CI = 1.36–3.45; p < 0.01), as well as and 1662 (45.8%) females. Gender data were missing parental substance use (OR = 2.45; 95% CI = 1.45–4.13; for 38 participants (1%). About a third of the students, p < 0.01) were associated with lifetime amphetamine use. (n = 1062; 32.5%) were aged 18  years or older. Students aged 14 years and below comprised 24.4% of the sample, Discussion those aged 15 years constituted 13.8%, while those aged The aim of this study was to examine the prevalence of 16 years and 17 years constituted 12.2% and 16.9% of the past-month cannabis use and lifetime amphetamine sample respectively. Over half of the students (54.5%) use and to determine associated factors among school- were in senior high schools while the remaining 45.5% going adolescents in Ghana. A prevalence rate of 5.3% were in junior high school. Past-month cannabis use was and 7.1% were found for past-month cannabis use and 5.3% and lifetime amphetamine use was 7.1% among lifetime amphetamine use respectively. The high preva- students. lence of past-month cannabis use in this study is lower to the reported rate of 7.2% found among adolescents in The relationship between cannabis and amphetamine use 2012 [6] but seems to indicate an increase compared to and their associated factors an earlier study that reported a prevalence rate of 2.6% The bivariate analysis of the factors associated with can- [7]. The prevalence rate of 5.3% reported in this study is nabis and amphetamine use among school-going ado- similar to a UNODC report [1] indicating that adolescent lescents in Ghana are presented in Table 2. Gender and past 30-day cannabis use was also low in Nigeria (4.4%) age were not associated with either past-month cannabis and Morocco (4.0%). A recent study also reported past use or lifetime amphetamine use. Mental health vari- 30-day cannabis use prevalence rates of 5.3%, 4.6% and ables such as loneliness, and suicidal behaviour (i.e. idea- 4.3% for Namibia, Swaziland, and Mauritius respectively tion, plan, and attempt) were related to cannabis use but [8]. In this study, the prevalence rate for lifetime amphet- only loneliness, suicidal plan, and attempt were related amine use was 7.1%, which is comparable to what has to amphetamine use. Personal attributes such as truancy been reported among school-going adolescents in previ- and cigarette smoking were independently associated ous studies within sub-Saharan Africa [4, 9, 23]. The high with both past-month cannabis use and lifetime amphet- prevalence rate for lifetime amphetamine use as found in amine use. A higher number of close friends was only this study is similar to a UNODC report which found a associated with past-month cannabis use. past year amphetamine prevalence rate of 7.6% among School environmental factors such as bullying victimi- students in Ghana [2]. The current trend for cannabis use sation and being physically attacked were associated with in the sub-Saharan Africa region is lower than the rates lifetime amphetamine use whilst bullying victimisation reported in this study. and hunger were related to past-month cannabis use. The results further showed that age and gender were Parental substance use was related to both past-month not significantly associated with either past-month can- cannabis use, and lifetime amphetamine use, but parental nabis use and lifetime amphetamine use. These results Oppong Asante Child Adolesc Psychiatry Ment Health (2019) 13:33 Page 5 of 9 Table 2 Bivariate analysis of  the  factors associated with  cannabis and  amphetamine use among  school-going adolescents in Ghana Variables Past‑month cannabis use Lifetime amphetamine use N = 184 N = 238 No (%) Yes (%) p‑value No (%) Yes (%) p‑value Demographics Gender 0.540 0.450 Male 95.1 4.9 93.3 6.7 Female 94.6 5.4 92.6 7.4 Age in years 0.055 0.120 11–17 years 94.2 5.8 92.4 7.6 18 years and above 95.8 4.2 93.9 6.1 Mental health problems Anxiety 0.068 0.052 Yes 91.7 8.3 87.6 12.4 No 95.3 4.7 93.8 6.2 Loneliness 0.032 0.018 Yes 91.5 8.5 88.7 11.3 No 95.4 4.6 93.7 6.3 Suicidal ideation 0.011 0.091 Yes 87.9 12.1 85.5 14.5 No 96.6 3.4 95.0 5.0 Suicidal plan 0.019 0.049 Yes 90.3 9.7 88.0 12.0 No 97.1 2.9 95.3 4.7 Suicidal attempt 0.028 0.012 Yes 85.5 14.5 82.3 17.7 No 97.8 2.2 96.3 3.7 Personal attributes Truancy < 0.001 < 0.001 Yes 89.0 11.0 87.6 12.4 No 98.2 1.8 96.0 4.0 Smoked cigarette < 0.001 0.003 Yes 54.9 45.1 56.2 43.8 No 97.3 2.7 95.5 4.5 Close friends 0.021 0.610 Yes 94.9 5.1 92.9 7.1 No 95.5 4.5 93.7 6.3 Peer support 0.680 0.720 Yes 94.6 5.4 92.7 7.3 No 94.9 5.1 93.0 7.0 Sexual risk behaviour 0.061 0.065 Yes 88.0 12.0 86.1 13.9 No 96.6 3.4 94.8 5.2 School environmental factors Bullying victimization 0.044 < 0.001 Yes 91.7 8.3 89.3 10.7 No 98.0 2.0 96.7 3.3 Physically attacked 0.060 < 0.001 Yes 90.4 9.6 87.6 12.4 No 97.8 2.2 96.5 3.5 Oppong Asante Child Adolesc Psychiatry Ment Health (2019) 13:33 Page 6 of 9 Table 2 (continued) Variables Past‑month cannabis use Lifetime amphetamine use N = 184 N = 238 No (%) Yes (%) p‑value No (%) Yes (%) p‑value Physical fight 0.058 0.049 Yes 90.7 9.3 88.6 11.4 No 97.1 2.9 95.3 4.7 Hunger 0.030 0.080 Yes 90.9 9.1 88.6 11.4 No 95.4 4.6 93.6 6.4 Parental attributes Parental substance use 0.018 < 0.001 Yes 81.7 18.3 79.6 20.4 No 96.5 3.5 94.8 5.2 Parental monitoring 0.070 0.270 Yes 95.6 4.4 92.3 7.7 No 94.3 5.7 93.3 6.7 Parental understanding 0.010 0.620 Yes 96.1 3.9 92.7 7.3 No 93.9 6.1 93.2 6.8 Parental bonding 0.110 0.890 Yes 95.6 4.4 93.2 6.8 No 94.3 5.7 93.0 7.0 Parental intrusion of privacy 0.060 0.090 Yes 95.4 4.6 93.6 6.4 No 93.9 6.1 92.1 7.9 contradict previous studies that have established such may also store drugs and/or alcohol in the house making associations [5, 8, 13]. Mental health variables such as these substances more readily available to young people anxiety, loneliness and suicidality did not predict either [25]. The third pathway is that substance use has a signifi- past-month cannabis or lifetime amphetamine use. These cant genetic component which explains why children of results contradict previous studies that have established parents who use substances also use substances [26]. In such associations [8–11]. Ghana, parental substance use may serve as a behavioural In this study, parental substance use was found to be model which young people living in the same household associated with lifetime amphetamine use. This means imitate. Thus, their behaviour may send a message to that school-going adolescents who reported parental sub- these adolescents that it is acceptable for them to do the stance use were more likely to engage in substance use. same. This result confirms evidence from previous studies [9, The results further showed that school-related vari- 19] which indicate that parental engagement in a behav- ables such as bullying victimisation and being physically ior is a huge predictor of offspring engaging in the same attacked were associated with lifetime amphetamine use. behaviour. Determining the association between parental The relationship between being physically attacked and substance use and adolescent substance use later in life lifetime amphetamine use is exceedingly complex and is not straightforward [24]. This relationship between may be moderated by a host of individual and environ- familial substance use and the likelihood of substance mental factors. It is, however, possible that interpersonal use in adolescence has been discussed through three (3) level risk factors within the school environment may have main pathways. One school of thought argues that fam- played a role in this association, as indicated by previous ily members with substance use problems may serve as studies [13, 15]. Additionally, the relationship between behavioural models for young people living in the same bullying victimisation and lifetime amphetamine use, household [19]. The second perspective indicates that could possibly be due to prior bullying victimisation family members living with problematic substance use that may predispose an adolescent to use amphetamine Oppong Asante Child Adolesc Psychiatry Ment Health (2019) 13:33 Page 7 of 9 Table 3 Association with  cannabis and  amphetamine use considerations for staff gatekeeping training programmes among school-going adolescents in Ghana to address bullying victimisation. Variables Past‑month Lifetime Previous studies have reported that having more cannabis use amphetamine friends is protective against substance use [17, 18]. How- use ever, the inverse was found in the present study where AOR 95% CI AOR 95% CI the odds of cannabis use increased with a higher number of close friends. It has been reported that friendship pro- Demographics vides a channel for adolescents to learn new social skills Age in years and subsequently experience positive developmental out- 11–17 years 1 – 1 – comes. However, it is possible that within the context of 18 years and above 0.91 0.51–1.62 0.98 0.62–1.55 this study, having several friends led to the development Sex (male) 0.74 0.43–1.28 1.07 of negative peer risk behaviours including substance use. Mental health problems Plausibly, such negative peer relationships may be asso- Anxiety 0.71 0.34–1.50 1.21 0.71–2.07 ciated with heightened health risk behaviours such as Loneliness 0.99 0.51–1.91 1.08 0.64–1.81 cannabis use, and thus underscore the need to empha- Suicidal ideation 1.84 0.97–3.50 1.51 0.88–2.60 size supportive relationships between peers and develop Suicidal plan 1.43 0.75 –2.73 1.18 0.68–2.03 strategies to promote positive peer support. Suicidal attempt 1.40 0.70 –2.80 1.44 0.81–0.59 The findings also reveal that school truancy was a Personal attributes risk factor for both past-month cannabis use and life- School truancy 3.34 1.88–5.92*** 1.74 1.13–2.68* time amphetamine use. Consistent with the results of Smoked cigarette 12.48 6.48–24.02*** 4.74 2.50–9.00*** this study, several studies have established a relation- Close friends 2.37 1.20–4.71* 1.43 0.79–2.60 ship between school truancy and illicit substance use Peer support 1.50 0.83–2.72 1.31 0.83–2.07 (i.e. cannabis and amphetamine use) [14–16, 19]. The Sexual risk behaviour 1.71 0.92–3.20 1.59 0.93–2.71 relationship between truancy and substance use may be School environmental factors attributed to the weakened sense of school belonging Bullying victimisation 1.65 0.87–3.13 2.09 1.27–3.43** among school-going adolescents. Schools are key social Physically attacked 1.61 0.89–2.93 2.16 1.36–3.45** institutions which play an important role in constraining Physical fight 1.54 0.84–2.82 0.94 0.58–1.52 problem behaviours among adolescents [31]. However, Hunger 0.99 0.49–1.99 1.35 0.78–2.33 since adolescence is also a time of increasing independ- Parental attributes ence and searching for autonomy [32], reduced school Parental substance use 1.88 0.97–3.64 2.45 1.45–4.13** engagement may also expose young people to health- Parental monitoring 0.90 0.50–1.79 1.31 0.82–2.11 compromising behaviours including substance use. It Parental understanding 0.75 0.39–1.41 1.58 0.99–2.51 should be noted, though, that while truancy was associ- Parental bonding 0.91 0.48–1.74 1.07 0.67–1.73 ated with substance use, not all truants use substances Parental intrusion of 1.04 0.60–1.80 1.09 0.71–1.68 [33]. privacy Furthermore, school-going adolescents who smoked AOR adjusted odds ratio for all factors which appear in table, CI confidence cigarettes were 12.5 and 4.8 times more likely to be past- interval month cannabis users and lifetime amphetamine users *p < 0.05; ** p < 0.01; *** p < 0.001 respectively. The presence of clustering of cigarette use with other illicit substance use including cannabis use has been reported in previous studies [8, 14, 34]. These find- as a maladaptive coping strategy. This finding may also ings underscore the need for the development of poly- provide some support for the stress coping and self- drug use interventions among school-going adolescents. medication model where recipients of peer victimisa- tion, particularly those with poor coping strategies or self-regulatory processes may use substances as a way Limitations of the study to deal with the pains associated with the victimisation This study has some limitations. Firstly, the key out- experience [27–29]. With no anti-bullying policy in place come variables, amphetamine and cannabis use, were within Ghanaian schools, in addition to the high preva- self-reported. Self-report may be confounded by sys- lence of bullying reported among adolescents [30], this tematic and social desirability biases. Secondly, the finding is a wake-up call for the Ghana Education Service majority of the measures used were single item meas- (GES). The GES should consider these pathways in policy ures which only allows narrow assessment of these variables. Thirdly, results are based on a cross-sectional database, thus limiting our ability to establish causality. Oppong Asante Child Adolesc Psychiatry Ment Health (2019) 13:33 Page 8 of 9 Longitudinal studies concerning amphetamine and can- Author details 1 nabis use among school-going adolescents are needed. Department of Psychology, University of Ghana, P. O. Box LG 84, Legon, Accra, Ghana. 2 Department of Psychology, University of the Free State, Bloemfontein, Finally, the study only included adolescents attending South Africa. 3 Institute for Psychosocial Research on Child and Adolescent school; out of school, 11–18 year-olds were not included. Wellbeing (IPRECAW), Accra, Ghana. Therefore, findings are not representative of all adoles- Received: 22 October 2018 Accepted: 22 August 2019 cents in this age group. Despite these limitations, this is one of the first cross-sectional studies to have used nationally representative data to explore the prevalence of cannabis and amphetamine use and their associated References factors among school-going adolescents. 1. United Nations Office on Drugs and Crime (UNODC). World drug report 2016. Sales No. E.16.XI.7, 2017. New York: United Nations Publication. 2. World Health Organization (WHO). Other psychoactive substances. 2017. Conclusion http://www.who.int/substa ncea buse/facts /psych oacti ves/en/. Accessed This study was conducted to examine the prevalence and 05 May 2018. factors associated with amphetamine and cannabis use 3. United Nations Office on Drugs and Crime (UNODC). World drug report among school-going  adolescents in Ghana. Although 2016. 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Kendler KS, Chen X, Dick D, Maes H, Gillespie N, Neale MC, Riley B. Publisher’s Note Recent advances in the genetic epidemiology and molecular genetics Springer Nature remains neutral with regard to jurisdictional claims in pub- of substance use disorders. Nat Neurosci. 2012;15:181–9. https: //doi. lished maps and institutional affiliations. org/10.1038/nn.3018. Ready to submit your research ? Choose BMC and benefit from: • fast, convenient online submission • thorough peer review by experienced rese archers in your field • rapid publication on acceptance • support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations • maximum visibility for your research: over 100M website views per year At BMC, research is always in progress. Learn more biomedcentral.com/submissions