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

Figures & data

Table 1 Variable Description

Variables	Question	Response Options
Age	“How old are you?”	11 years old or younger to 18 years old or older
Sex	“What is your sex?”	Male, female
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: most of the time or always)
Early cigarette use initiation	“How old were you when you first tried a cigarette?”	1=I have never smoked cigarettes; 2=7 years old or younger to 8=18 years old or older (coded 1=never, 2=2–4:<12 years, and 3=5–8:12–18 years)
Early alcohol use initiation	“How old were you when you had your first drink of alcohol other than a few sips?”	1=I have never had a drink of alcohol other than a few sips; 2=7 years old or younger to 8=18 years old or older (coded 1=never, 2=2–4:<12 years, and 3=5–8:12–18 years)
Early drug use Initiation	“How old were you when you first used drugs?”	1=I have never used drugs; 2=7 years old or younger to 8=18 years old or older (coded 1=never, 2=2–4:<12 years, and 3=5–8:12–18 years)
Current tobacco use	“During the past 30 days, on how many days did you smoke cigarettes/use any tobacco products other than cigarettes, such as pipes, roll your own cigarettes, or smokeless tobacco?”	1=0 days to 7=All 30 days (coded 1=0 and 2–7=1: at least 1 or 2 days)
Current alcohol use	“During the past 30 days, on how many days did you have at least one drink containing alcohol?”	1 = 0 days to 7 = All 30 days (coded 1=0 and 2–7=1: at least 1 or 2 days)
Current cannabis use	“During the past 30 days, how many times have you used marijuana (also called … country specific names)?”	1=0 times to 5=20 or more times (coded 1=0 and 2–5=1: at least 1 or 2 times)
Physically attacked	“During the past 12 months, how many times were you physically attacked?”	1=0 times to 8=12 or more times (coded 1=0 and 2–8=1: at least once)
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: at least once)
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: at least 1 or 2 days)
	Psychological distress
No close friends	“How many close friends do you have?”	1 = 0 to 4 = 3 or more (coded 1+=0, 0=1)
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)
Suicide ideation	“During the past 12 months, did you ever seriously consider attempting suicide?”	Yes, No
Suicide attempt	“During the past 12 months, how many times did you actually attempt suicide?”	1=0 times to 5=6 or more times (coded 1=0 and 2–5=1: 1 or more times)
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 support
Parental supervision	“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)
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)
Parental respect for privacy	“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)

Table 2 Descriptive Characteristics Of Substance Use Initiation

Variable	Onset Cigarette Smoking			Onset Alcohol Use			Onset Drug Use			Early Substance Use
	Non-Initiators	<12 Years	12–18 Years	Non-Initiators	<12 Years	12–18 yrs	Non-Initiators	<12 Years	12–18 Years	0	1	2 Or 3
	%	%	%	%	%	%	%	%	%	%	%	%
All (N=33,184)	76.9	10.6	12.4	73.2	8.1	18.6	93.8	4.2	1.9	86.0	10.6	3.4
Indonesia (33.6%)	77.8	11.0	11.2	91.2	3.9	4.9	97.3	2.1	0.6	88.6	9.6	1.8
Laos (11.1%)	88.3	3.3	8.4	36.9	6.9	56.2	97.6	0.6	1.8	91.4	6.9	1.7
Philippines (26.4%)	74.0	11.0	15.1	51.5	13.8	34.8	89.4	7.4	3.1	81.4	12.8	5.8
Thailand (17.8%)	78.9	9.4	11.7	55.3	12.1	32.6	90.1	5.5	4.4	85.0	10.2	4.9
Timor-Leste (11.2%)	66.7	9.9	23.4	70.2	14.1	15.7	90.4	7.0	2.6	83.9	11.0	5.0
Female (51.1%)	91.1	4.1	4.8	78.6	5.7	15.8	96.4	2.7	0.9	92.8	5.5	1.7
Male (48.9%)	61.7	17.6	20.7	67.5	10.7	21.8	91.1	5.8	3.0	78.3	16.3	5.4
Hunger (5.2%)	70.1	12.3	17.6	66.0	12.1	21.9	87.4	8.4	4.1	80.9	14.1	5.0
Current tobacco use (13.9%)	3.4	41.5	55.1	32.5	28.3	39.2	67.2	22.5	10.3	54.4	24.6	21.0
Current alcohol use (12.5%)	41.6	25.0	33.3	0	33.3	66.7	71.2	18.5	10.3	60.7	20.3	19.1
Current cannabis use (3.1%)	14.0	61.2	24.8	5.2	66.5	28.2	0	76.2	23.8	18.7	19.1	62.2
Physically attacked (33.1%)	66.8	16.7	16.5	65.6	13.1	21.4	89.1	8.2	2.8	78.6	14.5	6.9
In physical fight (28.0%)	61.3	19.4	19.3	59.3	15.8	24.9	86.1	9.9	4.0	75.0	16.5	8.5
Being bullied (30.6%)	70.2	15.4	14.4	60.3	15.3	24.5	87.8	9.2	3.0	78.4	14.3	7.3
Psychological distress
Low (76.8%)	80.9	7.7	11.4	79.6	4.6	15.8	97.4	1.3	1.3	89.3	9.3	1.4
Medium (14.6%)	72.6	14.3	13.1	62.0	13.4	24.6	88.4	8.7	2.8	80.8	12.9	6.4
High (8.6%)	62.6	17.9	19.4	46.8	20.3	32.9	84.5	11.3	4.3	73.7	16.5	9.8
Peer support (36.8%)	80.5	8.1	11.4	77.3	5.2	17.6	89.1	9.0	1.8	86.0	5.8	8.1
Parental support
Low (51.6%)	71.8	13.4	14.8	67.7	10.6	21.7	91.2	6.4	2.4	82.9	12.1	5.0
Medium (27.0%)	80.1	8.6	11.3	76.7	6.0	17.3	96.5	1.8	1.7	87.9	10.1	2.0
High (21.4%)	86.0	5.8	8.1	82.7	4.1	13.2	98.1	0.9	1.0	91.4	7.5	1.1

Table 3 Adjusted Prevalence Ratios For The Associations Of The Initiation Of Substance Use With Medium And High Psychological Distress

Variable	Medium Psychological Distress	High Psychological Distress
	ARRR (95% CI)^a	ARRR (95% CI)^a
Initiation of smoking cigarettes
Non-initiators	1 (Reference)	1 (Reference)
<12 years	1.51 (1.29, 1.77)***	2.46 (2.04, 2.98)***
≥12 years	0.87 (0.72, 1.07)	1.64 (1.30, 2.07)***
Initiation of alcohol use
Non-initiators	1 (Reference)	1 (Reference)
<12 years	1.92 (1.59, 2.31)***	3.05 (2.48, 3.75)***
≥12 years	1.24 (1.08, 1.43)**	1.73 (1.46, 2.06)***
Initiation of drug use
Non-initiators	1 (Reference)	1 (Reference)
<12 years	2.68 (2.04, 3.53)***	2.01 (1.31, 3.08)***
≥12 years	0.98 (0.64, 1.49)	1.07 (0.77, 1.48)
Initiation of substance use
0	1 (Reference)	1 (Reference)
1	1.35 (1.17, 1.56)***	1.71 (1.40, 2.09)***
2 or 3	2.58 (1.94, 1.56)***	3.23 (2.39, 4.38)***

Notes: ^aAdjusted for country, sex, age, socioeconomic status (hunger experience), current substance use, physically attacked, in physical fight, being bullied, peer and parental support; ***P<0.001; **P<0.01.

Abbreviation: ARRR, adjusted relative risk ratio.