There are approximately 1.8 billion young people (10–24 years old) worldwide and about 90% of them live in low- and middle-income countries (LMICs) (Wilson et al., 2020). Adolescence (will be used interchangeably with young people) is an important developmental stage which is characterized by significant physical, cognitive, emotional and social changes. These changes are often associated with stressors that are linked to both risk and opportunities for growth (Schulenberg, Sameroff, & Cicchetti, 2004). As one’s health status during adolescence is an important determinant of one’s health status in adulthood, this developmental phase provides an opportunity to improve health and well-being of young people. Some of the main contributors to adolescent health in LMICs which have attracted research attention include early pregnancy, sexually transmitted infection, and depression. Addictive problems such as problematic substance use and excessive use of social media are emerging problems among young people in LMICs, which need more research.
This special issue focuses on research on various types (e.g., nicotine, alcohol, and drug consumption; behavioural addiction such as internet, social media and smartphone use) and aspects of addictive problems (e.g., drug-related stigma, intervention) among young people in LMICs. Two articles are based on the analyses of a large secondary data set (i.e., Global School-based Student Health Survey (GSHS)), while other papers are based on recent studies conducted in India, Mexico, Turkey, the Philippines, Malaysia, Vietnam and Indonesia. The data were analysed using various statistical method such as meta-analytic random-effects regression, restricted maximum likelihood algorithms, parallel multiple meditation analyses.
Using the GSHS data set, de la Torre-Luque, Ozeylem, and Essau (2021) examined the prevalence of regular and problematic substance use (alcohol, tobacco, marijuana, and amphetamine use) among 314,187 adolescents from 73 LMICs. Their findings showed variations in the prevalence of various types of substances consumed by adolescents both within and between the LMICs in different continents. Adolescents in the Americas reported higher prevalence of problematic alcohol use than in other countries. Lowest prevalent of regular and problematic alcohol use was found in Senegal and Myanmar. Another study using the GSHS data set showed that adolescents who have experienced being bullied and not having any close friends were reported to have a high prevalence of alcohol and drug use.
A study by Wahab and colleagues, that involved inmates in a juvenile detention centre, showed a high prevalence of a lifetime history of substance use disorders (SUD). Adolescents exposed to peer/sibling victimisation were at a high risk of developing a SUD. In a study by Zohor Ali, Muhammad, Jamil, Ahmad, and Abd Aziz (2021), the prevalence of lifetime pornography exposure was high, being 74.5%. Significantly more males were exposed to pornography, they started at earlier age, were frequent users and using the internet alone at home. Another piece of research in this special issue is on waterpipe tobacco smoking, which is a traditional method of smoking tobacco among men in Turkey. This form of smoking has gained popularity among young people in various European countries in recent years. A study by Karaman, Çeber, and Eraslan (2022) showed waterpipe tobacco smoking to be common among university students in Turkey, especially among females. Waterpipe tobacco smokers perceived waterpipe tobacco to be less addictive than non-users.
In addition to problematic substance use or SUD, recent studies have focused on mobile phones/smartphones as these modern devices have significantly changed the way we live. Despite offering a wide range of benefits, excessive use of internet and smartphones could lead to problematic internet use; however, excessive use of internet and smartphones should not per se be regarded as a risk factor for unregulated use and/or negative outcomes as excessive internet use might be motivated by work/academic reasons.
Numerous studies have shown a growing number of young people with problematic internet use. Thus, it is important to have a reliable assessment tool that could be used to measure problematic internet use. The compulsive internet use scale (CIUS) is one of the most widely used, however its psychometric properties among adolescents in LMICs is lacking. To make up this gap, Fernandes, Aydin, Uzun, Tan-Mansukhani, and Biswas (2021) examined the psychometric properties of CIUS among young people in India, Philippines and Turkey. The results confirmed the single factor structure of the CIUS in these three countries. Problematic internet use was found to be predicted by high level of psychological distress and loneliness, and low self-esteem. Social media use was found to be significantly higher amongst adolescents in the Philippines, whereas gaming addiction was significantly higher in Turkey compared to adolescents in the other LMICs. The duration of time spent that young people spent on online gaming and social media during COVID-19-related lockdown/movement restriction have significantly increased compared to before the lockdown; participants with little self-control tended to have elevated scores on eating behavior, use of social media, and online gaming. Among young people in Turkey, a study by Akyol, Atalan Ergin, Krettmann, and Essau (2021) showed problematic mobile phone use to be associated with a high level of mental health problems, fear of missing out (FoMO), and escapism. However, the association between problematic mobile phone use and mental health problems was not mediated by FoMO and escapism.
SUD is a major public health concern because of its negative physical health, economic, and social consequences (Degenhardt, Stockings, Patton, Hall, & Lynskey, 2016). Stigma is likely to exacerbate these negative effects as it prevents young people with SUD from accessing drug treatment services (Kilian et al., 2021, World Health Organization, 2019) and could exclude them from having meaningful social interactions (Adlaf, Hamilton, Wu, & Noh, 2009). In a study by Topkaya, Şahin, Krettmann, and Essau (2021), female students in Turkey were found to report being more fearful of people who are addicted to these substances compared to males. Younger compared to older participants perceived people who are addicted to these substances as more dangerous. Perceived dangerousness and fearfulness partially mediated the relationship between perceived stigma and social distance in alcohol, marijuana and heroin.
While evidence-based interventions for addictive problems such as drug use problems are available in high-income countries, young people in LMICs do not have or have very little access to effective treatment. To address this accessibility gap and to increase quality and diversity of treatment options for adolescents with drug and other substance use disorders (SUDs), the Treatnet Family was developed specifically for adolescents with SUDs and their families in low resource settings. Treatnet Family focuses on family interactions and uses elements of family therapy to interrupt ineffective communication within the family. It contains the key components of family therapy, such as positive reframing, positive relational reframing, perspective taking, relational questions, and going with resistance. This special issue contains four articles on Treatnet Family, three of which were based on studies conducted in Indonesia and another one in Vietnam. Overall, the Treatnet Family can be delivered with adherence by practitioners in community-based settings. All practitioners reported that Treatnet Family training have enhanced their skills in working with adolescents and their family. Treatnet Family had a positive significant impact in reducing alcohol use among adolescents with substance-use problems. The number of adolescents who smoked cigarettes and marijuana, and used amphetamines also reduced across time.
In conclusion, investments in developing evidence-based intervention such as the Treatnet Family will not only have a positive impact on adolescent’s development, health and well-being, but also contribute to the achievement of the Sustainable Development Goals.
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