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Cannabis and Amphetamine Use 
Among Adolescents in Five Asian 
Countries 

 
Karl Peltzer1,2, Supa Pengpid2,3 
 
1HIV/AIDS/STIs/and TB (HAST), Human 
Sciences Research Council, Pretoria, 
South Africa;  
2Department of Research and 
Innovation, University of Limpopo, 
Turfloop, South Africa; 
3ASEAN Institute for Health 
Development, Mahidol University, 
Salaya, Phutthamonthon, 
Nakhonpathom, Thailand 

 
Vol. 6, No. 1 (2017)   |   ISSN 2166-7403 (online)  
DOI 10.5195/cajgh.2017.288 |   http://cajgh.pitt.edu 

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Central Asian Journal of Global Health 
Volume 6, No. 1 (2017) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2017.288|http://cajgh.pitt.edu 

 
 

Abstract 

Introduction: There has been a global increase in illicit drug use among young people. The aim of this study was to estimate the 
prevalence of lifetime cannabis and amphetamine use, as well as to explore factors associated with substance use among adolescents 
in five Asian countries: Iraq, Kuwait, Malaysia, Mongolia, and Vietnam.  
Methods: 38,941  school children (mean age 15.4 years, SD=1.5) completed the cross-sectional Global School-Based Student 
Health Survey (GSHS). Topics covered in the questionnaire included cannabis and amphetamine use. Personal, parental, and 
environmental attributes were explored as predictors of cannabis and amphetamine use. Logistic regression was used to assess the 
contribution of potential predictors on lifetime cannabis and lifetime amphetamine use. 
Results: Overall, the prevalence of lifetime cannabis use was 0.9% and lifetime amphetamine use was 1.0% among research 
participants. Cannabis use was influenced by male gender (Kuwait, Mongolia), parental smoking habits (Kuwait, Iraq), and current 
cigarette smoking in all countries. Amphetamine use was associated with suicidal ideation (Kuwait, Malaysia, Vietnam), school 
truancy (Malaysia, Mongolia, Vietnam), being a victim of physical assault (Kuwait, Mongolia), bullying victimization (Iraq, 
Malaysia, Vietnam), as well as anxiety and current cigarette use in all countries.   
Conclusions: Our preliminary results show the importance of personal attributes such as mental distress and environmental 
stressors on lifetime cannabis and lifetime amphetamine use. Future prospective studies are needed to identify causal relationships 
among personal attributes, parental attributes, environmental stressors, and illicit substance use. 

Keywords: Cannabis use; Amphetamine Use; Adolescents; Asia 

 
Cannabis and Amphetamine Use 
Among Adolescents in Five Asian 
Countries 

 
Karl Peltzer1,2, Supa Pengpid2,3 
 
1HIV/AIDS/STIs/and TB (HAST), Human 
Sciences Research Council, Pretoria, South 
Africa;  
2Department of Research and Innovation, 
University of Limpopo, Turfloop, South 
Africa; 
3ASEAN Institute for Health Development, 
Mahidol University, Salaya, 
Phutthamonthon, Nakhonpathom, Thailand 

Research 

Previous research suggested that substance use 
among youth under the age of 24 may have negative 
effects on cognitive and emotional development in the 
transition from adolescence to early adulthood.1 The 
initiation of substance use usually takes place during 
adolescence, mostly in the form of tobacco and alcohol 
use prior to the use of illicit drugs.1 A recent review 
reported that the global burden of disease attributable to 
substance use among adolescents and young adults has 
substantially increased.1  There are significant gaps in the 
literature regarding epidemiological data on the extent 
of illicit drug use among adolescents in Asia, which we 
are addressing in this paper.   

The World Health Organization (WHO), in 
collaboration with the Centers of Disease Control and 
Prevention (CDC) and national governments, have been 
conducting Global School-based Health Survey (GSHS) 
in various Asian countries to generate epidemiological 

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

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data on health behaviors, including illicit drug use.2 Since 
2010, a new module on cannabis and amphetamine use 
was added to GSHS, which was implemented in Iraq and 
Kuwait in the Middle East, in Mongolia in Central Asia, 
and in Malaysia and Vietnam in Southeast Asia.2 

Based on the WHO ATLAS on substance use 
disorders,3 the estimated 12-month prevalence of drug 
use disorders in 2004 was 0.24% among women (15 
years and over) and 0.66% among men (15 years and 
over) in Iraq. For Mongolia, the prevalence was 0.15% 
among women and 0.61% among men, and for Vietnam 
it was 0.10% among women and 0.47% among men.3 Al-
Hemiary et al.4 reported that there was an increase in 
illicit drug use, including cannabis (in the form of 
hashish) and methamphetamines in Iraq in the decade 
prior to 2012. In a study among male university students 
in Kuwait, the prevalence of lifetime illicit drug use was 
14.4%.5 In previous national school surveys, lifetime 
cannabis use was 1.5% among males and 0.4% among 
females (aged 12-19 years) in Malaysia,6 and the 
prevalence of lifetime illicit drug use among 
adolescents (12-19 years) was 1.7% in Malaysia.7 In a 
local survey in Malaysia conducted in 1979, Spencer 
and Navaratnam8 found that 11% of secondary students 
(12-19 years) had prior experience of drug use (mostly 
cannabis). In Vietnam, amphetamine use continues to 
increase, especially among adolescents in major cities.9 

In a previously published systematic review of 
cannabis use in high school and college students (≤18 
years) in Iran, the prevalence of lifetime cannabis use was 
5.0% (95% CI = 3.0%,7.0%).10 In a study focusing on 
high school students (mean age 15.0 years, SD=3.7) in 
Eastern India, the lifetime illicit drug use was 6.1% 
among rural and 0.6% among urban students.11 Lifetime 
illicit drug use was reported to be 7.9% among 
adolescents (15-18 years) attending primary health care 
centers in Saudi Arabia.12  In 38 European and North 
American countries, 19.9% of adolescents (22.9% of 
males and 17.0% of females) reported lifetime cannabis 
use.13 Among 15-16 year olds in Europe, lifetime 

amphetamine use ranged from 1% in Finland, Norway 
and Romania to 6% in Bulgaria and Latvia.14  Only a few 
studies were conducted in Asian countries, and 
information on the types of illicit drugs included in these 
studies was limited.15  

Risk factors for cannabis and/or amphetamine 
use among adolescents can be grouped following an 
ecological framework16 into 1) sociodemographic 
factors, 2) personal attributes, 3) parental attributes, 4) 
environmental stressors, and 5) peer factors. 
Sociodemographic factors influencing drug use include 
male gender17,18 and age.19 Personal attributes may 
include mental distress,20-22 smoking,7,18 school 
truancy,7,21 and lack of peer support.7 Parental attributes 
may include parental substance use,23 lack of parental 
support, including lack of parental monitoring,7,21,24 and 
lack of parental connectedness.21 Environmental 
stressors may include hunger, lower economic 
status,18,21,25 bullying, fighting,17,19 and aggression.26   

The aim of this study was to estimate the 
prevalence of cannabis and amphetamine use and explore 
factors associated with drug use among adolescents in 
five Asian countries. It was hypothesized that the 
prevalence of lifetime cannabis and amphetamine use 
was lower in Asian countries than in Europe and North 
America.  

 

Methods 

Participants 

This study was a secondary analysis of 
preexisting data from the GSHS from five Asian 
countries (limited to countries that utilized the cannabis 
and amphetamine use module). The purpose of the GSHS 
is to provide nationally representative data on health 
behaviors and protective factors among students aged 13-
17 years.2 The GSHS used a two-stage (schools and 
classrooms) cluster sampling design to produce 
nationally representative samples of students.2

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Variables Question Response options 

Cannabis use 

“During your life, how many times have you used marijuana (also called hashish)?” or other 

country specific names 

1=0 times, 2=1 or 2 times, 3=3-9 times, 
4=10-19 times and 5==20 or more 

times (coded 1=0 and 2-5=1) 

“During the past 30 days, how many times have you used marijuana (also called hashish)?” 

or other country specific names 

1=0 times, 2=1 or 2 times, 3=3-9 times, 
4=10-19 times and 5==20 or more 

times (coded 1=0 and 2-5=1) 

Amphetamine use 
“During your lifetime, how many times have you used amphetamines or methamphetamines 

(also called Parkizol or Artane)?” or other country specific names 

1=0 times, 2=1 or 2 times, 3=3-9 times, 
4=10-19 times and 5==20 or more 

times (coded 1=0 and 2-5=1) 

 Personal attributes  

Anxiety “During the past 12 months, how often have you been so worried about something that you 
could not sleep at night?” 

1=never to 5=always (coded 1–3=0 and 
4–5=1) 

Loneliness “During the past 12 months, how often have you felt lonely?” 1=never to 5=always (coded 1–3=0 and 
4–5=1) 

Suicidal ideation  “During the past 12 months, did you ever seriously consider attempting suicide?”  1 = yes, 2 = no  

 
Current smoking 

cigarettes “During the past 30 days, on how many days did you smoke cigarettes?” 1=0 days to 7=All 30 days (coded 1=0 
and 2-7=1) 

School truancy “During the past 30 days, on how many days did you miss classes or school without 
permission?” 

1=0 days to 5= 10 or more days (coded 

1=0 and 2–5=1) 

Peer support 
“During the past 30 days, how often were most of the students in your school kind and 

helpful?” 

1=never to 5=always (coded 1–3=0 and 
4–5=1) 

 Parental attributes  

Either or both parents 
use tobacco Which of your parents or guardians use any form of tobacco? 

1=neither, 2=my father or male 
guardian, 3=my mother or female 

guardian 

Parental monitoring 

“During the past 30 days, how often did your parents or 

guardians check to see if your homework was done?” 

1=never to 5=always (coded 1–3=0 and 
4–5=1) 

“During the past 30 days, how often did your parents or guardians go through your things 
without your approval?” 

1=never to 5=always (coded 1–3=0 and 
4–5=1) 

Parental connectedness 
“During the past 30 days, how often did your parents or 

guardians understand your problems and worries?” 

1=never to 5=always (coded 1–3=0 and 
4–5=1) 

Parental bonding 
“During the past 30 days, how often did your parents or guardians really know what you 

were doing with your free time? 

1=never to 5=always (coded 1–3=0 and 
4–5=1) 

 Environmental stressors  

Hunger 
“During the past 30 days, how often did you go hungry because there was not enough food 

in your home?" 

1 = never to 5 = always (coded 1–3=0 
and 4–5=1) 

Bullied “During the past 30 days, on how many days were you bullied?” 1=0 days to 7=All 30 days (coded 1=0 
and 2–7=1) 

In a physical fight “During the past 12 months, how many times were you in a physical fight?” 1=0 times to 8=12 or more times (coded 
1=0 and 2–8=1) 

Physically attacked “During the past 12 months, how many times were you physically attacked?” =0 times to 8=12 or more times (coded 
1=0 and 2–8=1) 

Table 1. Description of variables

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Students were requested to complete a self-administered 
questionnaire under the supervision of trained survey 
administrators.2 National Ethics Committees (e.g., in 
Kuwait: The Ministry of Health; in Malaysia: the 
Medical Research and Ethics Committee, Ministry of 
Health Malaysia; in Mongolia: the Committee on Ethics, 
Ministry of Health) approved the study protocol, and 
written informed consent was obtained from the students, 
parents, and/or school officials.2  

Questionnaire 

The GSHS questionnaire (translated into the 
national languages of the study countries) utilized in this 
study consisted of modules on tobacco cannabis and 
amphetamine use, violence, and a range of other health 
related behaviors, such as hygiene and physical activity, 
as well as demographics such as age and gender.2 The 
study variables are described in Table 1.  

Statistical analysis 

Descriptive statistics were used to describe the 
characteristics of participants and patterns of illicit drug 
use. Logistic regression was used for assessing the 
contribution of potential predictors (sociodemographic 
factors such as age and gender, personal attributes such 
as anxiety and current smoking, parental attributes such 
as parental tobacco use and parental monitoring, and 
environmental stressors such as experiencing hunger and 
being bullied) on lifetime cannabis and lifetime 
amphetamine use. All analyses were adjusted for the 
multi-stage stratified cluster sampling strategy, and 
performed using STATA software version 12.0 (Stata 
Corporation, College Station, TX, USA). 

 

Results 

The sample included 38,941 school-aged 
adolescents (mean age 15.4 years, SD=1.5), age range 
11-18 years, from Iraq (response rate=88%), Kuwait 
(85%), Malaysia (89%), Mongolia (88%), and Vietnam 
(response rate=96%). The range of students participating 

per country ranged from 2,038 in Kuwait to 25,507 in 
Malaysia. Across all respondents from all countries, 
lifetime cannabis use was 0.9%, ranging from 0.6% in 
Vietnam to 3.2% in Kuwait, and lifetime amphetamine 
use was 1.0%, ranging from 0.2% in Vietnam to 3.1% in 
Kuwait. The prevalence of past month cannabis use was 
2.1% in Iraq, 3.1% in Kuwait, 0.9% in Malaysia, and 
1.1% in Mongolia (Table 2). 

In multivariable unconditional regression analysis, male 
gender in Kuwait (OR=11.17, 95% CI=2.97, 42.02) and 
Mongolia (OR=2.01, CI=1.03, 3.95) was associated with 
lifetime cannabis use. In terms of personal attributes, 
anxiety (OR=2.48, 95% CI=1.19, 5.20) and suicidal 
ideation (OR=3.91, 95% CI=1.63, 9.35) in Kuwait, 
current smoking in all five countries (OR ranging from 
5.25 in Mongolia to 38.12 in Vietnam), and school 
truancy (OR=6.70, 95% CI=2.65, 16.96) in Vietnam 
were positively associated with lifetime cannabis use. 
School truancy was negatively associated with lifetime 
cannabis use (OR=0.35, 95% CI=0.17, 0.71) in Iraq. 
Lack of peer support (OR=0.39, 95% CI=0.22, 0.68) in 
Malaysia and having positive peer support (OR=2.73, 
95% CI=1.45, 5.15) in Mongolia were associated with 
lifetime cannabis use. In relation to parental attributes, 
parental or guardian tobacco use in Iraq (OR=2.59, 95% 
CI=1.04, 6.47) and Kuwait (OR=2.13, 95% CI=1.30, 
3.49) were associated with lifetime cannabis use. While 
lack of parental or guardian bonding (OR=0.40, 95% 
CI=0.24, 0.68) in Malaysia was associated with lifetime 
cannabis use, parental or guardian bonding (OR=5.18, 
95% CI=1.87, 14.37) in Vietnam and parental or 
guardian monitoring (OR=2.15, 95% CI=1.18, 3.90) in 
Malaysia were positively associated with lifetime 
cannabis use. With environmental stressors, food 
insecurity (OR=9.77, 95% CI=3.03, 31.56) in Iraq, being 
bullied (OR=11.26, 95% CI=1.83, 69.38) in Vietnam, 
and having been physically attacked (OR=2.14, 95% 
CI=1.02, 4.46) in Mongolia were associated with lifetime 
cannabis use (Table 3). 

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Variable 
Sample 

size 
Lifetime cannabis use Lifetime amphetamines use 

Past month 

cannabis 

use 

Country (study year)  All Males Females All Males Females All 

  N (%) N (%) N (%) N (%) N (%) N (%) N (%) 

Iraq (2012) 2038  (2.4) 30 (3.0) 13 (1.6)  (2.6) 27 (2.7) 20 (2.4) 42 (2.2) 

Kuwait (2011) 2672  (3.2) 77 (5.7)  6 (0.4) (3.1) 61 (5.0) 8 (0.7) 80 (3.1) 

Malaysia (2012) 25507  (0.9) 173 (1.5) 37 (0.4)  (1.0) 179 (1.6) 37 (0.4) 208 (0.9) 

Mongolia (2013) 5393  (1.3) 43 (1.8) 22 (0.8)  (1.7) 43 (1.9) 36 (1.3) 53 (1.1) 

Vietnam (2013) 3331  (0.6) 14 (6.7) 4 (1.1)  (0.2) 12 (0.9) 4 (0.3) NA 

All 38941  (0.9) 337 (1.5) 82 (0.4)  (1.0) 332 (1.4) 105 (0.6) 383 (1.5) 

NA = Not assessed 

Table 2. Prevalence of drug use in five Asian countries 

In multivariable unconditional regression 
analysis, male gender (OR=4.76, 95% CI=1.10, 20.55) in 
Kuwait, younger age (OR=0.78, 95% CI=0.63, 0.98) in 
Malaysia, and older age (OR=1.84, 95% CI=1.07, 3.15) 
in Vietnam were associated with lifetime amphetamine 
use. In terms of personal attributes, anxiety (OR= ranging 
from 2.29 in Kuwait to 3.82 in Iraq), current smoking 
(OR=ranging from 2.68 in Mongolia to 17.23 in 
Vietnam) in all countries, suicidal ideation in Kuwait 
(OR=3.19, 95% CI=1.35, 7.55), Malaysia (OR=2.28, 
95% CI=1.26, 4.12) and Vietnam (OR=6.86, 95% 
CI=1.07, 43.91), and school truancy in Malaysia 
(OR=2.31, 95% CI=1.40, 3.81), Mongolia (OR=1.90, 
95% CI=1.11, 3.28) and Vietnam (OR=9.12, 95% 
CI=3.06, 27.19) were  associated with lifetime 
amphetamine use. Lack of peer support (OR=0.35, 95% 
CI=0.20, 0.62) was associated with lifetime 
amphetamine use in Malaysia. In relation to parental 
attributes, no associations were found with lifetime 
amphetamine use. With environmental stressors, 
experiencing food insecurity (OR=4.98, 95% CI=1.35, 
18.33) in Iraq, being bullied in Iraq (OR=5.16, 95% 
CI=1.55, 17.18), Malaysia (OR=2.51, 95% CI=1.55, 

4.08) and Vietnam (OR=9.16, 95% CI=1.05, 79.60), and 
having been physically attacked in Kuwait (OR=2.27, 
95% CI=1.14, 4.52) and Mongolia (OR=3.07, 95% 
CI=1.55, 6.07) were associated with lifetime 
amphetamine use (Table 4).  

 
Discussion 

In this study of school-going adolescents in five 
Asian countries from Middle East, Central Asia, and 
Southeast Asia the prevalence of lifetime cannabis and 
amphetamine use was found to be generally lower than 
previously reported in North America and Europe,13,14 
India,11 Iran10 and Saudi Arabia,12 but was similar to 
previously reported results in Malaysia.6,7 Compared to 
the studied countries, the higher prevalence of cannabis 
and possibly amphetamine use in North America and 
Europe may be related to a greater cannabis 
liberalization.13 

This study demonstrated a large geographic 
variation in the prevalence of lifetime and past month 
cannabis use and lifetime amphetamine use,

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Variable AOR (95% CI) AOR (95% CI) AOR (95% CI) AOR (95% CI) AOR (95% CI) 

 Iraq Kuwait Malaysia Mongolia Vietnam 

Sociodemographic      

Age (years) 0.63 (0.35, 1.11) 0.99 (0.75, 1.31) 1.00 (0.80, 1.26) 0.93 (0.74, 1.17) 1.16 (0.66, 2.02) 

Gender 

   Females (48.2%) 

   Males (51.8%) 

 

Reference 

0.75 (0.14, 3.91) 

 

Reference 

11.17 (2.97, 42.02)*** 

 

Reference 

1.51 (0.77, 2.99) 

 

Reference 

2.01 (1.03, 3.95)* 

 

Reference 

0.93 (0.05, 16.98) 

Personal attributes      

Anxiety (14.4%) 0.77 (0.29, 2.04) 2.48 (1.19, 5.20)* 1.73 (0.89, 3.36) 2.01 (0.79, 5.14) Not assessed 

Loneliness (15.3%) 2.02 (0.74, 5.50) 1.35 (0.60, 3.04) 1.91, 0.98, 3.71) 1.09 (0.45, 2.67) 1.82 (0.36, 9.23) 

Suicidal ideation (19.1%) 2.52 (0.95, 7.05) 3.91 (1.63, 9.35)** 1.74 (0.87, 3.50) 1.46 (0.56, 3.83) 1.69 (0.29, 9.93) 

Current smoking (8.9%)  9.20 (3.62, 23.41)*** 7.30 (2.34, 22.73)** 11.06 (5.41, 22.60)*** 5.26 (2.35, 11.81)*** 
38.12 (8.02, 

181.19)*** 

School truancy (36.6%) 0.35 (0.17, 0.71)** 1.34 (0.84, 2.13) 2.07 (0.90, 4.76) 1.86 (0.88, 3.97) 6.70 (2.65, 16.96)*** 

Peer support (29.2%) 0.60 (0.13, 2.72) 0.65 (0.26, 1.62) 0.39 (0.22, 0.68)*** 2.73 (1.45, 5.15)** 1.41 (0.51, 3.89) 

Parental attributes      

Either or both parents use 

tobacco (21.4%) 
2.59 (1.04, 6.47)* 2.13 (1.30, 3.49)** 1.03 (0.71, 1.49) 1.34 (0.65, 2.77) Not assessed 

Parental or guardian 

monitoring (25.6%) 
0.40 (0.12, 1.32) 0.99 (0.49, 2.02) 2.15 (1.18, 3.90)* 0.69 (0.39, 1.24) 0.26 (0.04, 1.54) 

Parental or guardian 

connectedness (31.9%) 
1.13 (0.47, 2.75) 1.82 (0.50, 6.67) 1.02 (0.67, 1.57) 0.77 (0.29, 2.00) 0.40 (0.05, 3.42) 

Parental or guardian bonding 

(36.4%) 
0.22 (0.05, 1.06) 1.34 (0.66, 2.72) 0.40 (0.24, 0.68)*** 0.54 (0.28, 1.04) 5.18 (1.87, 14.37)** 

Environmental stressors      

Hunger (11.2%) 9.77 (3.03, 31.56)*** 1.24 (0.48, 3.21) 1.35 (0.70, 2.61) 2.87 (0.65, 12.69) Not assessed 

Bullied (45.1%) 1.25 (0.47, 3.32) 1.70 (0.60, 4.80) 1.59 (0.96, 2.61) 0.78 (0.36, 1.66) 11.26 (1.83, 69.38)** 

In physical fight (44.8%) 1.12 (0.33, 3.80) 1.01 (0.51, 2.00) 1.84 (0.84, 4.03) 1.33 (0.61, 2.86) 0.95 (0.37, 2.49) 

Physically attacked (34.0%) 1.10 (0.41, 2.96) 1.43 (0.66, 3.12) 1.10 (0.64, 1.88) 2.14 (1.02, 4.46)* 0.49 (0.19, 1.26) 

AOR = Adjusted Odds Ratio; CI = Confidence Interval; ***P<0.001; **P<0.01; *P<0.05 

Table 3. Factors associated with lifetime cannabis use 

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with a higher prevalence in Iraq and Kuwait, and lower 
prevalence in Malaysia, Mongolia, and Vietnam. The 
higher prevalence of cannabis and amphetamine use in 
Iraq may be explained by a high degree of exposure to 
environmental stressors, such as ongoing violence and 
unrest, as well as the experience of hunger or food 
insecurity. The relatively low lifetime amphetamine use 
in Southeast Asia (Malaysia and Vietnam) in this study 
may reflect a further stabilizing of the past “peak of the 
methamphetamine epidemic” in Southeast Asia.27 The 
low prevalence of illicit drug use in Malaysia may also 
be attributed to school prevention programs.7 

Overall, the study found that a higher number of 
males when compared to females were lifetime cannabis 
users in Kuwait and Mongolia. Lifetime amphetamine 
use among males in Kuwait was higher in males. There 
was no significant gender difference in the other 
countries, which is an interesting finding. The role of 
gender in substance abuse requires further 
investigation28, as UNODC29 noted that the “gender gap 
(i.e. the difference between the prevalence of substance 
use among males and females) has in fact been closing.” 
The gender difference in Kuwait and Mongolia may 
reflect stronger gender role differences that predispose 
men to engage in substance use behavior when compared 
with Iraq, Malaysia, and Vietnam.20 

The study found that adolescents who were 
current smokers were more likely to be lifetime 
amphetamine users. This seems to indicate that certain 
problem behaviors may become a trend during 
adolescence, and the use of one drug may lower the 
barriers of taking another drug.30 Poly-drug use (tobacco 
use and cannabis and/or other drugs) has also been 
reported by previous studies18,31,32 and suggests the need 
for poly-drug use interventions. 

When it comes to personal attributes, mental 
distress (anxiety and suicidal ideation) and school 
truancy were found to be associated with cannabis and 

amphetamine use in several countries that we 
investigated, corroborating previous studies in Malaysia 
and Africa.7,19-21 Having mental distress may increase 
adolescents’ vulnerability to drug use.16 Adolescents who 
are mentally distressed may use cannabis and/or 
amphetamine to alter their well-being,33 or they may want 
to cope with mental distress by using illicit drugs.20  Illicit 
drug use or school truancy may be seen as a marker of 
other deviant behaviors, which may lead to a greater 
likelihood of experimenting with cannabis and/or 
amphetamine use outside of school settings.34 In 
agreement with a previous study,5 this study found an 
association between lack of peer support and cannabis 
and amphetamine use in Malaysia, but not in the other 
countries. Strong peer relations or support may help to 
protect from illicit drug use.   

Regarding parental attributes, this study 
corroborated a study from Ghana,23 suggesting that 
parental tobacco use was associated with lifetime 
cannabis use. Parents play an important role in the 
formation of norms and practices among adolescents.35 
Adolescents are more likely to engage in similar behavior 
as their parents when it comes to substance abuse 
behaviors.35 Although parental or guardian monitoring 
and/or bonding was protective from cannabis use in 
Malaysia, none of the parental support measures were 
protective in relation to lifetime amphetamine use, unlike 
in findings from previous investigations.7,21,24 Parental 
monitoring and bonding behavior may demonstrate 
concern and support, which may prevent children from 
the development of illicit drug use habits.23  

In agreement with previous studies,17-19,21 this 
study found that environmental stressors, including 
experiencing hunger (or low socioeconomic status), 
being bullied and having been physically attacked, were 
associated with lifetime cannabis and/or amphetamine 
use in several countries. It is possible that adolescents 
who experience various forms of environmental stressors 
are more likely to associate themselves with deviant

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Variable AOR (95% CI) AOR (95% CI) AOR (95% CI) AOR (95% CI) AOR (95% CI) 

 Iraq Kuwait Malaysia Mongolia Vietnam 

Sociodemographic      

Age (years) 0.75 (0.51, 1.10) 0.86 (0.59, 1.26) 0.78 (0.63, 0.98)* 1.02 (0.82, 1.26) 1.84 (1.07, 3.15)* 

Gender 

   Females (48.2%) 

   Males (51.8%) 

 

Reference 

0.88 (0.20, 4.08) 

 

Reference 

4.76 (1.10, 20.55)* 

 

Reference 

1.47 (0.75, 2.90) 

 

Reference 

0.92 (0.52, 1.64) 

 

Reference 

2.78 (0.10, 79.01) 

Personal attributes      

Anxiety (14.4%) 3.82 (1.08, 13.50)* 2.29 (1.68, 3.14)*** 2.52 (1.36, 4.66)** 2.82 (1.36, 

5.86)** 

Not assessed 

Loneliness (15.3%) 0.76 (0.13, 4.55) 1.06 (0.58, 1.94) 1.71 (0.90, 3.25) 0.91 (0.40, 2.06) 0.91 (0.16, 5.18) 

Suicidal ideation (19.1%) 1.28 (0.30, 5.50) 3.19 (1.35, 7.55)* 2.28 (1.26, 4.12)** 1.32 (0.67, 2.62) 6.86 (1.07, 43.91)* 

Current smoking (8.9%)  6.66 (2.03, 

15.74)** 

5.97 (2.92, 

12.20)*** 

5.73 (3.47, 

0.48)*** 

2.68 (1.28, 

5.62)** 

17.23 (3.07, 96.77)** 

School truancy (36.6%) 0.63 (0.27, 1.49) 1.36 (0.89, 2.08) 2.31 (1.40, 

3.81)*** 

1.90 (1.11, 3.28)* 9.12 (3.06, 27.19)*** 

Peer support (29.2%) 0.48 (0.16, 1.45) 0.87 (0.35, 2.13) 0.35 (0.20, 

0.62)*** 

1.32 (0.50, 3.48) 2.27 (0.64, 7.98) 

Parental attributes      

Either or both parents use 

tobacco (21.4%) 

1.87 (0.76, 4.59) 1.74 (0.87, 3.49) 0.95 (0.62, 1.44) 1.35 (0.73, 2.49) Not assessed 

Parental or guardian 

monitoring (25.6%) 

0.74 (0.25, 2.22) 0.99 (0.56, 1.78) 1.70 (0.95, 3.05) 0.62 (0.30, 1.30) 0.59 (0.05, 6.77) 

Parental or guardian 

connectedness (31.9%) 

0.40 (0.06, 2.59) 1.40 (0.51, 3.88) 0.77 (0.42, 1.40) 0.35 (0.10, 1.28) 0.13 (0.01, 3.09) 

Parental or guardian 

bonding (36.4%) 

0.45 (0.07, 2.98) 1.07 (0.52, 2.24) 0.65 (0.38, 1.14) 0.80 (0.36, 1.78) 3.62 (0.80, 16.37) 

Environmental 

stressors 

     

Hunger (11.2%) 4.98 (1.35, 18.33)* 1.15 (0.39, 3.43) 1.35 (0.51, 3.56) 0.88 (0.10, 7.56) Not assessed 

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Central Asian Journal of Global Health 
Volume 6, No. 1 (2017) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2017.288|http://cajgh.pitt.edu 

 
 

Bullied (45.1%) 5.16 (1.55, 

17.18)** 

2.20 (0.63, 7.77) 2.51 (1.55, 

4.08)*** 

1.13 (0.55, 2.34) 9.16 (1.05, 79.60)* 

In physical fight (44.8%) 1.16 (0.38, 3.51) 0.97 (0.38, 2.51) 1.72 (0.99, 2.99) 2.05 (0.93, 4.53) 0.94 (0.15, 5.72) 

Physically attacked 

(34.0) 

0.62 (0.27, 1.43) 2.27 (1.14, 4.52)* 1.26 (0.77, 2.07) 3.07 (1.55, 

6.07)** 

0.55 (0.08, 3.56) 

AOR = Adjusted Odds Ratio; CI = Confidence Interval; ***P<0.001; **P<0.01; *P<0.05 

Table 4. Factors associated with lifetime amphetamine use

peers in trying to cope with a stressful environment, and 
thus more likely engage in illicit drug use.16  

Due to the cross-sectional study design, causal 
inferences cannot be made. Further, the self-report of 
illicit cannabis and amphetamine use may be interpreted 
with caution because of poor memory recall and possibly 
underreporting of illicit drug use. Moreover, several 
indicators, such as anxiety and loneliness were only 
measured with single question items, which has its 
limitations. Some of the variables (anxiety, parental 
tobacco use, and food insecurity) assessed in the GSHS 
were not available for all the countries our study was 
focusing on, which need to be further investigated. 

This study found that relatively low proportion 
of adolescents in five Asian countries engage in cannabis 
and amphetamine use, and identified various risk factors 
associated with its use. Our findings contribute to the 
body of knowledge on illicit drug use among adolescents 
in Asian countries, which can facilitate effective global 
policy responses. School health policy and interventions 
should target the prevention of cannabis and 
amphetamine use, while taking into account 
environmental stressors and personal attributes such as 
anxiety and school truancy. Translational research may 
help in identifying the risk factors most amenable to 
address or change in the future public health 
interventions focusing on reduction in illicit drug use. 
Future prospective studies are needed to identify causal 
relationships among personal attributes, parental 
attributes, environmental stressors, and illicit substance 
use. 

 

Acknowledgements 

We thank the World Health Organization for 
making the data available for analysis, and the Ministries 
of Education and Health. We also would like to thank the 
study participants for making the GSHS possible. 

  

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This journal is published by theUniversity Library System of the University of Pittsburgh as part  
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

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Volume 6, No. 1 (2017) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2017.288|http://cajgh.pitt.edu 

 
 

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	Cannabis and Amphetamine Use Among Adolescents in Five Asian Countries
	Abstract
	Keywords: Cannabis use; Amphetamine Use; Adolescents; Asia
	Cannabis and Amphetamine Use Among Adolescents in Five Asian Countries
	Research

