Abstract
Aim
Alcohol, tobacco and cannabis use, early sexual debut and suicidality among young people are public health issues. This study sought to explore associations between health-risk behaviours (use of alcohol, tobacco and cannabis, mental health and suicidality) and protective factors among in-school Himalayan secondary students from Bhutan and Nepal.
Subjects and methods
Secondary analyses of WHO Global School Health Survey data obtained from the cross-sectional surveys of in-school Himalayan secondary students from Bhutan (2016, n = 7576) and Nepal (2015, n = 6529).
Results
Findings showed a concerning level of suicidality in both countries, early commencement of alcohol use, higher prevalence of current cannabis and alcohol use in Bhutan, and low condom use overall.
Conclusion
Preventive health activities that target students at younger ages, males in particular, need strengthening, as do risk reduction efforts to delay onset of substance use and sexual debut and strategies to increase protective factors such as retention and participation in education.
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Availability of data and material
All data are publicly available in the WHO website: https://www.who.int/ncds/surveillance/gshs/datasets/en/
Code availability
Not applicable.
References
Aryal K, Bista B, Dhimal M, Khadka B, Pandey A, Mehta R et al (2017) Global School Based Student Health Survey Nepal. Nepal Health Research Council, Kathmandu, p 2017 http://nhrc.gov.np/wp-content/uploads/2017/10/Final-GHSH-cover-with-annex.pdf
Aryal N, Adhikari R (2019) Cannabis in Nepal and scopes of its re-legalization. Am J Agric Res 4:47 https://escipub.com/ajar-2019-04-1507/
Bista B, Thapa P, Sapkota D, Sing S, Pokhara P (2016) Psychosocial problems among adolescent students: an exploratory study in the Central Region of Nepal. Frontiers in Public Health 4158:1–7. https://doi.org/10.3389/fpubh.2016.00158
Dash G, Thomsen K, Ewing S, Silvers J (2020) Foundations of addictive problems in adolescents: neurobiological factors. In: Essau C, Delfabbro P (eds) Adolescent addiction; epidemiology, assessment and treatment. 2nd edn. Academic, London, pp 19–41
Degenhardt L, Stockings E, Hall W, Lynskey M (2016) The increasing global health priority of substance in young people. Lancet Psychiatry 3:251–264. https://doi.org/10.1016/S2215-0366(15)00508-8
Degenhardt L, Wolfe D, Hall W, Hickman M, Chang J, Bruneau J et al (2019) Strategies to reduce drug-related harm: responding to the evidence base. Lancet 394:1491–1493. https://doi.org/10.1016/S0140-6736(19)32232-9
Dema T, Tripathy J, Thinley S, Rani M, Dhendup T, Laxmeshwar C. et al. (2019) Suicidal ideation and attempt among school, going adolescents in Bhutan: a secondary analysis of a global school-based student health survey in Bhutan 2016. BMC Public Health 191605:1–12. https://doi.org/10.1186/s12889-019-7791-0.
Dendup T (2016) Alcohol consumption and academic performance among higher secondary students in Thimphu, Bhutan. Bhutan Health J 2(2):1–5 http://www.bhj.com.bt/index.php/bhj/article/view/27
Department of Youth and Sports (2011) National Youth Policy. Government of Bhutan, Thimphu (http://www.education.gov.bt/wp-content/downloads/publications/publication/youth-policy-1.pdf)
Dorji L (2012) Alcohol use and abuse in Bhutan. Monograph series, number 1. National Bureau of Statistics, Government of Bhutan, Thimphu http://www.nsb.gov.bt/publication/files/pub1vc5889ov.pdf
Dorji L (2015) Sexual and reproductive health of adolescents and youth in Bhutan. National Bureau of Statistics, Government of Bhutan, Thimphu https://bhutan.unfpa.org/sites/default/files/pub-pdf/SRH%20of%20Youths%20and%20Adolescents%20in%20Bhutan.pdf
Dorji L, Gyeltshen S, Jamtsho C, Minten T, Dorjee T, Namgay P, Wangchuk T (2015) Crime and mental health issues among the young Bhutanese people. National Bureau of Statistics, Government of Bhutan, Thimphu http://www.nsb.gov.bt/news/news_detail.php?id=183&task=view
Durgana R, Bista B, Pandey A, de Courten M (2019) Prevalence, clustering and sociodemographic distributions of non-communicable disease risk factors in Nepalese adolescents: secondary analysis of a nationwide school survey. BMC Open 9(5). https://bmjopen.bmj.com/content/9/5/e028263
Gubbles J, van der Put C, Assink M (2019) Risk factors for school, absenteeism and dropout: a meta-analytic review. J Youth Adolescence 48:1637–1667. https://doi.org/10.1007/s10964-019-01072-5
Gurung A, Shrestha N, Silwal M, Gurung R, Ojha S (2016) Prevalence of substance use and associated factors among high school adolescents in Rithepani, Lekhnath-2, Kaski, Nepal. J Gandaki Med College Nepal 10(1):43–48 https://www.nepjol.info/index.php/JGMCN/article/view/17915
Hall W, Patton G, Stockings E, Weiner LM, Morley K, Degenhardt L (2016) Why young people’s substance use matters for global health. Lancet Psychiat 3:264–279. https://doi.org/10.1016/S2215-0366(16)00013-4
IndexMundi (2020) https://www.indexmundi.com/nepal/demographics_profile.html
Kakchapati S, Shrestha B, Li D, Rajbhandari R, Poudel T (2018) Drug use, injecting behaviors, and survival sex among street children and youths in Kathmandu Valley, Nepal. Int J STD and AIDS 29(6):588–597 https://doi.org/10.1177/0956462417746532
Karki S, Laukkanen E, Länsimies H, Tuomainen T, Pietilä A (2019) Substance use and associated emotional and behavioural problems in Nepalese use adolescents. J Sub Use 24(3):300–308 https://doi.org/10.1080/14659891.2018.1562576
Khatiwada N, Silwal P, Bhadra R, Tamang T (2013) Sexual and reproductive health of adolescents and youth in Nepal: trends and determinants. Further analysis of the. Nepal Demographic and Health Survey. Population Division, Ministry of Health and Population, Kathmandu, p 2011 https://dhsprogram.com/publications/publication-fa76-further-analysis.cfm
Liu X, Huang Y, Liu Y (2018) Prevalence, distribution, and associated factors of suicide attempts in young adolescents: school-based data from 40 low-income and middle-income countries. PLOS One 13(12):1–12. e0207823. https://doi.org/10.1371/journal.pone.0207823
Ministry of Education Bhutan, Nossal Institute for Global Health & Centre for Research Institute Bhutan (2011) An assessment of vulnerable and at-risk adolescents (13–18 years) in Bhutan: Exploring social and health risk behaviours. Department of Youth and Sports, Ministry of Education Bhutan. In: Nossal Institute for Global Health. University of Melbourne, and Centre for Research Institute, Thimphu http://old.aidsdatahub.org/assessment-vulnerable-and-risk-adolescents-13-18-years-bhutan-department-youth-and-sports-ministry
Ministry of Health and Population, Nepal (2011) Nepal adolescent and youth survey 2011: highlights. Population Division, Ministry of Health and Population. Government of Nepal, Ramshahpath https://nepal.unfpa.org/en/publications/nepal-adolescents-and-youth-survey-201011-highlights
Ministry of Youth and Sports (2015) National Youth Policy. Nepal Ministry of Youth and Sports, Kathmandu http://www.moys.gov.np/sites/default/files/nitiheru/National%20Youth%20Policy%202072_2.pdf
Nepal Law Commission (2018) The Public Health Services Act, 2075 (2018). http://www.lawcommission.gov.np/en/archives/20751
Norbu T, Perngparn U (2014) Drugs and alcohol use by secondary school students in Thimphu, Bhutan. J Health Res 28(3):173–182 https://he01.tci-thaijo.org/index.php/jhealthres/article/view/93530
Panda S, Chowdhury L, Dendup T, Pahari S (2009a) Drug use situation and responses in schools and communities: a rapid assessment in Phuentsholing, Bhutan. United Nations Office on Drugs and Crime and Bhutan Narcotic Control Agency, Royal Government of Bhutan, Thimphu https://www.unodc.org/documents/southasia/reports/Drug_use_situation_and_responses_in_schools_and_communities.pdf
Panda S, Wangdi C, Mukherjee D, Chowdhury L, Wangdi S, Pahari S (2009b) National baseline assessment of drugs and controlled substance use in Bhutan 2009, United Nations Office on Drugs and Crime and Bhutan Narcotic Control Agency. Royal Government of Bhutan, Thimphu https://www.unodc.org/documents/southasia/reports/National_Baseline_Assessment_of_Drugs_and_Controlled_Substance_use_in_Bhutan_2009.pdf
Pandey A, Bista B, Dhungana R, Kumar K, Chalise B, Dhimal M (2019) Factors associated with suicidal ideation and suicidal attempts among adolescent students: findings from Global School Based Students Health Survey. PLOS One 19:1–13. https://doi.org/10.1371/journal.pone.0210383
Pathak R, Pokharel T (2012) Sexual and reproductive health status of adolescents and youth in Nepal. Nepal Population J 17(16):131–141 https://dms.nasc.org.np/sites/default/files/documents/Trilochan%20Article%20SRH.pdf
Peltzer K, Pengpid S (2017a) Cannabis and amphetamine use among adolescents in five Asian countries. Central Asian J Global Health 6(1):288 https://cajgh.pitt.edu/ojs/index.php/cajgh/article/view/288
Peltzer K, Pengpid S (2017b) Suicidal ideation and associated factors among students aged 13–15 years in Association of Southeast Asian Nations (ASEAN) member states 2007–2013. Int J Psychiat Clin Pract 21(3):201–208. https://doi.org/10.1080/13651501.2017.1301486
Preyde M, Furtado J, Head S, Long D (2020) Foundations of addictive problems in adolescence; developmental and social factors. In: Essau C, Delfabbro P (eds) Adolescent addiction; epidemiology, assessment and treatment. 2nd edn (pp. 3–16). Academic Press, London ISBN: 978–0–12-818,626-8
Royal Government of Bhutan (2010 and2014) Tobacco control act of Bhutan. Royal Government of Bhutan, Thimphu. https://www.nationalcouncil.bt/assets/uploads/docs/acts/2014/Tobacco_Control_Act_of_Bhutan,_2010eng5th.pdfand http://extwprlegs1.fao.org/docs/pdf/bhu162887.pdf
Royal Government of Bhutan (2015a) National policy and strategic framework to reduce harmful use of alcohol (2015–2020). Royal Government of Bhutan, Thimphu. https://www.gnhc.gov.bt/en/wp-content/uploads/2017/05/FINAL_APPROVED-ALCOHOL-POLICY-AND-STRATEGIC-FRAMEWORK-latest.pdf
Royal Government of Bhutan (2015b) Suicide prevention in Bhutan: a three-year plan (July 2015–June 2018). Royal Government of Bhutan, Thimphu http://www.moh.gov.bt/wp-content/uploads/moh-files/2019/09/Suicide-Prevention-Action-Plan.pdf
Sheehan P, Sweeny K, Rasmussen B, Wils R, Friedman H, Mahon J et al (2017) Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents. Lancet 390:1792–1806. https://doi.org/10.1016/S0140-6736(17)30872-3
Sherab K, Howard J, Tshomo S, Tshering K (2017) Substance use, mental health and sexual behaviour of college students in Bhutan. Journal of Applied Youth Studies 2(2):3–17
Stockings E, Hal W, Lynskey M, Morley K, Reavley N, Strang J et al (2016) Prevention, early intervention, harm reduction, and treatment of substance use in young people. Lancet Psychiatry 3:280–296. https://doi.org/10.1016/S2215-0366(16)00002-X
Thapa B, Powell J, Yi J, McGee J, Landis J, Rein L et al (2017) Adolescent health risk and behaviour survey: a school-based survey in Central Nepal. Kathmandu Univ Med J 60(4):301–307 http://www.kumj.com.np/issue/60/301-307.pdf
Thapa N, Arya K, Paudel M, Puri R, Thapa P, Shrestha S et al (2015) Nepalese home brewed alcoholic beverages: types, ingredients, and ethanol concentration from a nationwide survey. J Nepal Health Res Council 13(29):59–65 https://www.researchgate.net/publication/282441711_Nepalese_Homebrewed_Alcoholic_Beverages_Types_Ingredients_and_Ethanol_Concentration_from_a_Nation_Wide_Survey
Timalsina M, Kafle M, Timalsina R (2018) Psychosocial problems among school going adolescents in Nepal. Psychiatry J 4675096:6. https://doi.org/10.1155/2018/4675096
Tshomo U, Sherab K, Howard J (2020) Bhutanese trainee student teachers’ knowledge, attitudes and practices about sex and sexual health: exploring the impact of intervention programmes. Sex Education 20(6):627–641. https://doi.org/10.1080/14681811.2020.1719480
Upadhyaya S (2017) A cross-sectional study on health-risk behavior among school students studying in grade 8 to 10 in Kathmandu. Thesis submitted as part of requirements for degree of MD (Psychiatry). Department of Psychiatry and Health, Institute of Medicine, Tribhuvan University, Kathmandu
World Economic Forum (2020) A global framework for youth mental health: investing in future mental health capital for individuals, communities and economies. World Economic Forum, Geneva. https://www.weforum.org/reports/a-global-framework-for-youth-mental-health-db3a7364df
World Health Organization (WHO) (2010) A conceptual framework for action on the social determinants of health. WHO, Geneva https://www.who.int/social_determinants/publications/9789241500852/en/
World Health Organization (WHO) (2020) Global school-based student health survey (GSHS). https://www.who.int/ncds/surveillance/gshs/en/
World Health Organization Regional Office for South-East Asia (WHO-SEARO) (2017) Mental health status of adolescents in South-East Asia: evidence for action. World Health Organization, Regional Office for South-East Asia, New Delhi https://apps.who.int/iris/handle/10665/254982
World Health Organization, Regional Office for South-East Asia (WHO-SEARO) (2020) South-East Asian Regional Microdata Repository: Global School-based Student Health Survey (GSHS). https://nada.searo.who.int/index.php/catalog/GSHS.
World Health Organization, Regional Office for South-East Asia and Comprehensive School Health Programme, Health Promotion Division, Department of Public Health, Thimphu, Ministry of Health, Royal Government of Bhutan. (WHO-SEARO et al.) (2017) Report on Bhutan Global School-based Student Health Survey (GSHS) 2016. WHO-SEARO, New Delhi https://apps.who.int/iris/handle/10665/272768
Acknowledgements
We would like to thank: the Nepal Health Research Council, Ministry of Health and Population, Kathmandu, Nepal, and the Comprehensive School Health Program, Ministry of Health, Thimphu, Bhutan, who managed the GSHS study in their countries. Noncommunicable Diseases and Mental Health, WHO, Geneva, and WHO-SEARO for making the GSHS data publicly available. Participating schools and students. Associate Professor Margo Barr, Epidemiologist, Centre for Primary Health Care and Equity, Medicine, UNSW, Sydney. Associate Professor Frederic Sitas, Director, Centre for Primary Care and Equity, Medicine, UNSW, Sydney.
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Contributions
All authors contributed to the study conception and design. The study was conceived by John Howard, with contributions from Kezang Sherab, Sagun Pant and Catherine Spooner. The methodology section, analyses and results were performed and reported by Catherine Spooner, Bihungum Bista and Shreeram Upadhyaya. The first draft of the manuscript was written by John Howard, with additional contributions by Kezang Sherab and Sagun Pant, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Ethical approval
The study complies with Ethical Standards, and approval was obtained.Ethics approvals for the 2015 and 2016 WHO GSHS studies were provided by the Ethical Review Board, Nepal Health Research Council, the Research Ethics Board of Health Bhutan, as per WHO GSHS site.
Ethics Approval for the secondary analyses in this study was provided by the University of New South Wales-Sydney Human Research Ethics Advisory Panel (HC200164).
Consent to participate
The WHO GSHS survey forms contain the following: “DO NOT write your name on this survey or the answer sheet. The answers you give will be kept private. No one will know how your answer. Answer the questions based on what you really know or do. There is no right or wrong answers. Completing the survey is voluntary. Your grade or mark in this class will not be affected whether or not you answer the questions. If you do not want to answer a question, just leave it blank.”
Informed consent was not required for this study, as it was a secondary analyses of publicly available data provided in the WHO website: https://www.who.int/ncds/surveillance/gshs/datasets/en/
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Not applicable. Participants in the WHO GSHS understand that the data generated will be published and “be used to develop better health programs for young people like yourself.”
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The authors declare that they have no conflict of interest.
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Howard, J., Spooner, C., Sherab, K. et al. Substance use, suicidality and sexual activity among secondary school adolescents from Bhutan and Nepal. J Public Health (Berl.) 31, 405–416 (2023). https://doi.org/10.1007/s10389-021-01514-0
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DOI: https://doi.org/10.1007/s10389-021-01514-0