Beyond Prevalence: Understanding Substance Use Behaviors and Associated Risks in Ethnic Minority Students at Primary-Secondary Transition

Beyond Prevalence: Understanding Substance Use Behaviors and Associated Risks in Ethnic Minority Students at Primary-Secondary Transition | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Beyond Prevalence: Understanding Substance Use Behaviors and Associated Risks in Ethnic Minority Students at Primary-Secondary Transition Pimpisa Chomsri, Surinporn Likhitsathian, Mullika Matrakul, Soontaree Suratana, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7439535/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Research on substance use among ethnic minority students during the critical primary-to-secondary school transition in Northern Thailand remains limited. This study investigated substance use experiences, associated risks, and key demographic and behavioural factors in this vulnerable population. A cross-sectional study was conducted with 186 ethnic minority students (Grades 4–6) in Chiang Rai, Thailand, using the Alcohol, Smoking and Substance Involvement Screening Test-Youth (ASSIST-Y). Data were analysed using descriptive statistics and chi-square tests. Lifetime substance use prevalence was low (e.g., alcohol 8.6%, tobacco 5.9%), yet most users were classified at a moderate-risk level. Lifetime use was significantly associated with being male (χ²=12.545, p = .001), being in a higher grade level (χ²=7.840, p = .020), and exhibiting deviant behaviour (χ²=9.046, p = .003). Despite low prevalence, a concerning profile of moderate-to-high risk exists. The findings identify a vulnerable subgroup (males, older students, and those with behavioural issues), highlighting the need for targeted, gender-sensitive prevention programs during this critical school transition. substance use ethnic minority adolescents Thailand New Contribution to the Literature This study makes several key contributions to the literature on youth substance use and minority health. First, it provides novel epidemiological data on a severely under-researched and vulnerable population: ethnic minority children in Northern Thailand during the primary-to-secondary school transition. Second, it moves beyond simple prevalence reporting to uncover a critical public health paradox, demonstrating that low rates of substance use can mask a significant underlying profile of moderate-to-high risk. Third, by empirically identifying male gender, higher grade level, and co-occurring deviant behaviour as strong statistical predictors, this study elucidates the primary mechanisms of risk in this specific context. Finally, these findings provide a crucial, evidence-based foundation for the development of targeted, culturally-sensitive prevention policies aimed at mitigating health disparities in this population. Background Substance use among children and adolescents continues to be a significant global public health concern. According to the United Nations Office on Drugs and Crime (UNODC), a substantial proportion of individuals initiate substance use during adolescence, with early initiation linked to increased vulnerability to long-term negative outcomes [ 1 ]. Although prevalence varies by region, the global data highlight adolescence as a high-risk period. In Southeast Asia, the problem is particularly pressing due to the region’s complex drug production and trafficking landscape. Studies have reported increasing substance use trends among youth, often driven by socio-economic vulnerabilities, peer influences, and access to substances [ 2 ] In Thailand, national surveys have consistently shown that substance use initiation commonly occurs in early adolescence, with some substances, such as alcohol, tobacco, and kratom, being used at higher rates among younger age groups compared to older adolescents or the general population [ 3 ]. This early exposure underscores the need for timely and developmentally appropriate prevention strategies. Research also shows that early initiation of substance use is strongly associated with increased risk of later substance use disorders, poor educational, and cognitive outcomes, and mental health problems such as anxiety and depression [ 4 , 5 ]. Moreover, substance use during childhood and adolescence may increase the likelihood of engaging in risky behaviours, criminal activity, and experiencing strained social and familial relationships [ 5 ]. Despite growing recognition of the adolescent substance use problem in Thailand, limited research has explored this issue in the context of ethnic minority populations, particularly those in the upper primary school years. This developmental stage—the transition from primary to secondary education—is a critical period characterized by increasing autonomy, identity exploration, and heightened susceptibility to peer influence [ 6 ]. These factors may contribute to the initiation of risk behaviours, including substance use. Chiang Rai Province, in Northern Thailand near the Golden Triangle, an area known for illicit drug production and trafficking, presents a particularly unique risk environment. The province is home to diverse ethnic minority groups such as the Akha, Lahu, Hmong, and Yao, many of whom live in rural, resource-limited areas and face barriers related to language, access to education, and healthcare services [ 7 , 8 ]. These structural and socio-cultural factors may heighten vulnerability to early substance use, yet a lack of empirical research is focused specifically on this population. While some studies have addressed adolescent drug use in Northern Thailand more broadly, few have examined ethnic minority students at the crucial developmental transition between upper primary and lower secondary school. Addressing this gap is essential for the development of effective, culturally appropriate prevention strategies. A nuanced understanding of the prevalence, patterns, and risk levels of substance use among ethnic minority students can inform interventions that are tailored to their specific socio-cultural and geographic contexts. Therefore, this study aimed first, to investigate the substance use experiences and to assess the associated risk levels, and second, to explore the association between key environmental and behavioural factors (i.e., parental use, peer use, and deviant behaviour) and substance use among ethnic minority students in the upper primary education level. Conceptual framework This study's conceptual framework posits that lifetime substance use initiation among ethnic minority students in Northern Thailand is the outcome of converging risks across demographic, developmental, and behavioural dimensions. These factors are not direct causes but operate through distinct underlying mechanisms: male sex is driven by a bio-sociocultural pathway of slower neurological maturation and gendered social norms; higher grade level operates through a developmental-social pathway of increasing autonomy and peer influence; and deviant behaviour is explained by a shared vulnerability mechanism, suggesting substance use is part of a broader syndrome of externalizing behaviours. The confluence of these pathways creates a heightened state of risk, identifying a specific vulnerable subgroup and explaining how and why substance use initiation emerges in this population. Methods This research employed a cross-sectional survey design to investigate substance use experiences and assess the associated risk levels among ethnic minority students in the upper primary education level at a single point in time. 1. Participants Population This research targeted all ethnic minority students currently enrolled in Prathom 4 (Grade 4) to Prathom 6 (Grade 6) in schools in Chiang Rai Province. Sample Due to the large population size, a sampling method was necessary to obtain a representative sample. The multi-stage sampling process involved three distinct steps. First, two districts within Chiang Rai Province were purposively selected based on their high concentration of ethnic minority populations. Second, a simple random sampling was used to select five schools from the list of all primary schools within these two districts. Finally, all ethnic minority students enrolled in Grades 4 to 6 in the selected schools who met the inclusion criteria were invited to participate in the study. The sample size was based on an appropriate sample size calculation formula for survey research, considering the desired level of confidence and margin of error. 2. Data Collection Prior to fieldwork, questionnaires and related documents were prepared, and research assistants were trained in data collection procedures, interview techniques, and research ethics. Permission to conduct the research was first secured from school administrators. Subsequently, information sheets and parental consent forms were sent home with the students for their legal guardians to review and sign. Research assistants then held a separate session with the students to explain the study in simple, age-appropriate language, ensuring they understood the purpose of the research and that their participation was completely voluntary. Verbal assent was obtained from each student prior to data collection, in addition to the written informed consent from their guardians. It was emphasized that students could withdraw from the study at any time without any negative consequences. Data were subsequently collected from the student sample at selected schools, where participants completed questionnaires under supervision, with focus group discussions utilized to gather more in-depth information. Following data collection, all data were reviewed for completeness and accuracy, entered into a suitable database, and stored systematically and securely to maintain participant confidentiality. 3. Measures The general information questionnaire consisted of items assessing sex, ethnicity, current grade level, parental substance use, close friends' substance use, and engagement in deviant behaviour. The Alcohol, Smoking and Substance Involvement Screening Test-Youth (ASSIST-Y) is a screening tool for youth developed with the support of the World Health Organization (WHO) by a team of addiction researchers and clinicians. It assesses experiences with alcohol consumption, smoking, and substance use. Its reliability has been tested, yielding a Cronbach's alpha of 0.80. The ASSIST-Y yields a Specific Substance Involvement score for each substance category based on responses to questions concerning frequency of use, craving, and related problems. For this study, risk levels were categorized based on the standard scoring protocol developed for youth. Following the established guidelines, scores of 0–3 were categorized as low risk (indicating a need for health education), scores of 4–15 as moderate risk (indicating a brief intervention is appropriate), and scores of 16 or higher as high risk (indicating a need for referral to specialist assessment and treatment). [ 9 ] Deviant behaviour was assessed using a checklist of five items adapted from previous youth risk surveys. Students were asked whether, in the past year, they had engaged in any of the following behaviours: (1) getting into a physical fight, (2) skipping school without permission, (3) lying to parents or guardians, (4) stealing something of value, or (5) intentionally damaging property. A dichotomous variable was created where participants who responded 'yes' to one or more of these items were categorized as 'engaging in deviant behaviours'. 4. Analysis Data were analysed using. Descriptive statistics, including frequencies and percentages, were used to summarize the participants' demographic characteristics, substance use prevalence, and associated risk levels. To explore the mechanisms of risk, chi-square tests of independence were performed to examine the association between various risk factors and lifetime substance use. Fisher's Exact Test was utilized when expected cell counts were less than five. The alpha level for all tests was set at p < .05. 5. A statement indicating ethical review Ethics approval: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. The study was approved by the Research Ethics Committee of Chiang Rai Provincial Public Health Office (Approval code: CRPPHO No. 94/2564). Consent to participate: Informed consent to participate in the study was obtained from the legal guardians of all individual participants included in the study. Results Table 1 presents the demographic characteristics of the participants ( N = 186). The sample comprised slightly more females (54.8%, n = 102) than males, with the majority of participants identifying as Hmong (59.7%, n = 111). Regarding environmental factors, more than a quarter of participants (27.4%, n = 51) reported having a parent who used substances, and nearly a quarter (23.1%, n = 43) reported engaging in deviant behaviours. Full demographic details are available in Table 1. Table 1 Demographic Characteristics of Study Participants ( n = 186) Characteristics n % Sex Male 894 45.2 Female 102 54.8 Ethnicities Hmong 111 59.7 Akha 36 19.4 Other 39 21.0 Education Prathom 4 (Grade 4) 69 37.1 Prathom 5 (Grade 5) 51 27.4 Prathom 6 (Grade 6) 66 35.5 Parental substance use Used substances 51 27.4 Non-used substances 135 72.6 Close friends' substance use Used substances 23 12.4 Non-used substances 163 87.6 Deviant behaviour Engaging in deviant behaviours 43 23.1 Never engaging in deviant behaviours 143 76.9 Table 2 details the lifetime and past 3-month prevalence of substance use, which was generally low overall. Alcohol and tobacco products were the most common substances reported for lifetime use, at 8.6% ( n = 16) and 5.9% ( n = 11), respectively. This pattern persisted for past 3-month use, where alcohol (7.0%, n = 13) and tobacco (2.7%, n = 5) remained the most frequently used substances. The prevalence for all other substances was considerably lower, with zero reported use of heroin, tranquilizers, or hallucinogens in the past three months. Specific prevalence rates for each substance are shown in Table 2. Table 2 Prevalence of Lifetime and Past Three-Month Substance Use Among Participants. Substances n (%) Lifetime substance use Past 3-month substance use Tobacco products 11 (5.9) 5 (2.7) Alcohol 16 (8.6) 13 (7.0) Cannabis 7 (3.8) 3 (1.6) Amphetamine 3 (1.6) 1 (0.5) Glue/thinner 4 (2.2) 1 (0.5) Kratom 6 (3.2) 2 (1.1) Heroin 3 (1.6) 0 (0) Tranquilizers 3 (1.6) 0 (0) Hallucinogens 3 (1.6) 0 (0) Other substances 4 (2.2) 1 (0.5) Table 3 displays the distribution of all participants across risk levels associated with past 3-month substance use. For alcohol, the most commonly used substance, the majority of the sample was classified as low risk (81.2%, n = 151). However, a different pattern emerged for most other substances, where the majority of the sample was categorized as being at a moderate risk, including for tobacco (96.8%), cannabis (96.8%), and amphetamine (97.8%). Of particular concern, despite very low prevalence rates, a small number of individuals were classified as high risk for use of tranquilizers (3.8%, n = 7), heroin (3.2%, n = 6), and other substances (3.8%, n = 7). This indicates the presence of a highly vulnerable subgroup, as detailed in Table 3. Table 3 Distribution of Participants ( n = 186) Across Different Levels of Risk Associated with Their Substance Use in the Past Three Months Substances Risk levels associated with past 3-month substance use Low n (%) Moderate n (%) High n (%) Tobacco Products 3 (1.6) 180 (96.8) 3 (1.6) Alcohol 151 (81.2) 32 (17.2) 3 (1.6) Cannabis 3 (1.6) 180 (96.8) 3 (1.6) Amphetamine 2 (1.1) 182 (97.8) 2 (1.1) Glue/Thinner 2 (1.1) 182 (97.8) 2 (1.1) Kratom 2 (1.1) 181 (97.3) 3 (1.6) Heroin 3 (1.6) 177 (95.2) 6 (3.2) Tranquilizers 3 (1.6) 176 (94.6) 7 (3.8) Hallucinogens 3 (1.6) 182 (97.8) 1 (0.5) Other substances 3 (1.6) 176 (94.6) 7 (3.8) Table 4 presents the results of the Chi-square tests examining the association between demographic, environmental, and behavioural factors and lifetime substance use. The analysis revealed that several factors were significantly associated with substance use. A highly significant association was found between sex and substance use (χ² = 12.545, p = .001), with male students representing a much larger proportion of substance users than female students. Furthermore, education level was also significantly associated with substance use (χ² = 7.840, p = .020), indicating that students in higher grades, particularly Grade 6, were more likely to have used substances. The most critical behavioural factor was deviant behaviour, which showed a highly significant association with substance use (χ² = 9.046, p = .003). Students who engaged in deviant behaviours were substantially more likely to be substance users compared to those who did not. Table 4 Relationship Between Demographic, Environmental, and Behavioural Factors and Lifetime Substance Use Lifetime substance use n(%) χ² p -value Never Yes Sex 12.545 a .001** Male 72 (41.62 12 (92.31) Female 101 (58.38) 1 (7.69) Ethnicities 1.228 a .541 Hmong 104 (60.12) 7 (53.85) Akha 32 (18.50) 4 (30.77) Other 37 (21.39X 2 (15.38) Education 7.840 a .020* Prathom 4 (Grade 4) 68 (39.31) 1 (7.69) Prathom 5 (Grade 5) 48 (27.75) 3 (23.08) Prathom 6 (Grade 6) 57 (32.95) 9 (69.23) Parental substance use .079 a .754 Yes 47 (27.17) 4 (30.77) No 126 (72.83) 9 (69.23) Close friends' substance use 4.368 a .060 Yes 19 (10.98) 4 (30.77) No 154 (89.02) 9 (69.23) Deviant behaviour 9.046 a .003** Yes 72 (41.62) 11 (84.62) No 101 (58.38) 2 (15.38) *p-value<.05, ** p-value<.01 a Fisher’s Exact Test Discussion This study provides a nuanced understanding of substance use among ethnic minority students during the critical primary-to-secondary school transition in a high-risk region of Northern Thailand. The findings reveal two central insights. First, while the overall prevalence of substance use is currently low, the pattern of use is consistent with established literature, showing alcohol and tobacco as the primary "gateway" substances for this young population [10, 11]. Second, and more critically, this study uncovers a concerning paradox: despite low prevalence rates, the majority of young users are classified at a moderate-risk level, with a small but significant subgroup identified as high risk for severe substances like heroin and tranquilizers. This study transitioned from a descriptive prevalence survey to an analytical exploration of the mechanisms underlying substance use initiation among ethnic minority students in Northern Thailand. By analysing key risk factors, our findings identify specific, vulnerable subgroups and offer a clearer understanding of why risk emerges in this population. The discussion now centres on the three factors that demonstrated a significant statistical association with lifetime substance use: sex, education level, and deviant behaviour. The most pronounced finding was the strong association between sex and substance use, with male students accounting for over 90% of users. This aligns with global epidemiological data but our study suggests the mechanisms are already at play in late childhood. Recent research posits that this gender disparity is driven by a convergence of neurobiological and sociocultural factors. Boys, on average, exhibit a slower maturation of the prefrontal cortex, which governs impulse control, making them more susceptible to risk-taking behaviours [12]. Concurrently, sociocultural norms often equate masculinity with experimentation and resilience in the face of risk, creating an environment where substance use initiation is perceived as a normative part of male social development [13]. Thus, the mechanism is likely a dual pathway of heightened biological propensity and social reinforcement. Our analysis also revealed a significant relationship between education level and substance use, with a clear concentration of users in Grade 6. This finding highlights the primary-to-secondary school transition as a critical window of vulnerability. The mechanism here is developmental; as students progress to the final year of primary school, they experience a sharp increase in autonomy, decreased parental supervision, and a fundamental shift in their social worlds [14]. The desire for social acceptance intensifies, and peer groups become the dominant socializing force. For students in Grade 6, substance use may serve as a social tool to signal maturity or gain entry into desired peer groups as they anticipate the move to secondary school, a period known for increased risk exposure [15]. Perhaps the most compelling finding is the powerful association between deviant behaviour and substance use, where students exhibiting such behaviours comprised nearly 85% of all users. This provides strong evidence for a "shared vulnerability" or "common liability" mechanism in this population. Rather than viewing substance use as an isolated act, this finding suggests it is part of a broader syndrome of externalizing behaviours [16]. The underlying mechanism posits that a common set of factors—such as temperamental traits like poor impulse control, sensation-seeking, and exposure to adverse environments—predisposes certain children to a range of problem behaviours, including aggression, defiance, and substance use initiation [17, 18]. Therefore, early substance use in our sample appears to be a symptom of a more general difficulty with behavioural regulation, not simply a standalone choice. Interestingly, factors such as parental and close friends' substance use did not demonstrate a statistically significant relationship in this analysis, contrary to much of the established literature. This may be due to several factors, including statistical power limitations given the small number of users in the sample, or the possibility that social influence at this age is more subtle than what can be captured by a direct 'yes/no' question. Nonetheless, the clear significance of the other factors provides a robust model for understanding risk. This deeper, mechanism-focused analysis allows for a more targeted approach to prevention. The "window of opportunity" identified previously can now be specified: intervention efforts should be prioritized for male students, particularly as they approach Grade 6, and especially for those who exhibit early signs of externalizing or deviant behaviours. Prevention programs should be tailored to address the underlying mechanisms, such as by incorporating gender-sensitive modules that challenge risky social norms for boys and by focusing on building general self-regulation and social-emotional skills for children with conduct problems [12]. By understanding and targeting the why behind the risk, we can move beyond prevalence to implement truly effective, evidence-based prevention for this vulnerable population. This research, while providing valuable insights, has certain limitations. A significant limitation of this study is the application of the ASSIST-Y and its standard risk categories to a population younger than its primary validation range. While the ASSIST-Y is designed for adolescents, its specific scoring cutoffs for 'moderate' and 'high' risk have not been formally validated for children aged 9-12 or specifically for ethnic minority populations in Thailand. Therefore, the interpretation of these risk levels should be approached with caution, as the clinical meaning of a 'moderate' risk score in a 10-year-old may differ from that in a 16-year-old. Future research is critically needed to validate substance use screening tools and establish developmentally appropriate risk thresholds for this specific age and cultural context. The cross-sectional design precludes the establishment of temporal relationships between risk factors and substance use. Furthermore, reliance on self-reported data may be subject to recall and social desirability biases. However, the study's strength lies in its focus on an under-researched and highly vulnerable population in a key geographical region, contributing vital data to the field. Future research should employ longitudinal designs to track the developmental trajectories of substance use in this cohort as they are exposed to increasing risk factors in adolescence [6]. Qualitative studies are also essential to gain a richer contextual understanding of the socio-cultural factors influencing these behaviours and to inform the development of more effective, culturally-adapted interventions. Declarations Consent to participate: Informed consent to participate in the study was obtained from the legal guardians of all individual participants included in the study. Funding Declaration This work was supported by the National Research Council of Thailand (NRCT); and the Centre of Excellence for the Hill Tribe Health Research and Training, Mae Fah Luang University. Partial financial support was also received from Chiang Mai University. The funding sources had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Author Contribution Each author certifies that their contribution to this work meets the standards of the International Committee of Medical Journal Editors. Acknowledgement This study was accomplished with the support of all relevant sectors. This research project has been funded by the National Research Council of Thailand (NRCT) and the Center of Excellence for the Hill Tribe Health Research and Training, Mae Fah Luang University, Chiang Rai, Thailand. This research was partially supported by Chiang Mai University. References United Nations Office on Drugs and Crime. World drug report 20232023. ASEAN Training Center for Preventive Drug Education. Youth and substance use in Southeast Asia: Emerging trends and responses.2021. Office of the Narcotics Control Board. National report on drug situation in Thailand 20222022. Squeglia LM, Jacobus J, Tapert SF. The influence of substance use on adolescent brain development. Clin EEG Neurosci. 2009;40(1):31-8. Fergusson DM, Boden JM. Cannabis use and later life outcomes. Addiction. 2008;103(6):969-76; discussion 77-8. Steinberg L. A Social Neuroscience Perspective on Adolescent Risk-Taking. Dev Rev. 2008;28(1):78-106. Wongphanit N, Tanskul S, Maneepong C. Ethnic minority education and health service accessibility in northern Thailand: Challenges and opportunities. . Journal of Population and Social Studies. 2018;26:101-15. International Crisis Group. Thailand: The evolving conflict in the south. Asia Report No. 241 2010. Drug and Alcohol Services South Australia. Instruction for Clinicians: How to administer the ASSIST-Y and linked Intervention to young people aged 15-17 years. South Australia: Drug and Alcohol Services South Australia 2011. Kandel DB, Yamaguchi K, Chen K. Stages of progression in drug involvement from adolescence to adulthood: further evidence for the gateway theory. Journal of studies on alcohol. 1992;53(5):447-57. National Institute on Drug Abuse. Monitoring the Future 2023 Survey Results: Trends in adolescent drug use2023 May 24, 2025. Anderberg M, Dahlberg M. Gender differences among adolescents with substance abuse problems at Maria clinics in Sweden. Nordic Studies on Alcohol and Drugs. 2018;35(1):24-38. Stewart R, Wright B, Smith L, Roberts S, Russell N. Gendered stereotypes and norms: A systematic review of interventions designed to shift attitudes and behaviour. Heliyon. 2021;7(4):e06660. DeCamp W, Bakken N. Transitioning to Middle School in the Sixth Grade: A Hierarchical Linear Modeling (HLM) Analysis of Substance Use, Violence, and Suicidal Thoughts. Journal of Early Adolescence - J EARLY ADOLESCENCE. 2010;30:895-915. Letina S, Long E, McCrorie P, Mitchell K, Zucca C, Riddell J, et al. Cross-sectional social network study of adolescent peer group variation in substance use and mental wellbeing: The importance of the meso level. Social Networks. 2024;78:119-37. Köck P, Meyer M, Elsner J, Dürsteler KM, Vogel M, Walter M. Co-occurring Mental Disorders in Transitional Aged Youth With Substance Use Disorders – A Narrative Review. Frontiers in Psychiatry. 2022;Volume 13 - 2022. Garon-Carrier G, Pascuzzo K, Gaudreau W, Lemelin J-P, Déry M. Maternal Functioning and Child's Externalizing Problems: Temperament and Sex-Based Driven Effects. Frontiers in Psychology. 2022;Volume 13 - 2022. Brieant A, King-Casas B, Kim-Spoon J. Transactional relations between developmental trajectories of executive functioning and internalizing and externalizing symptomatology in adolescence. Development and psychopathology. 2022;34(1):213-24. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 18 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Submission checks completed at journal 03 Sep, 2025 First submitted to journal 23 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7439535","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":517231994,"identity":"0b8d3fe4-63eb-42a4-bd49-0c7dc89fdadf","order_by":0,"name":"Pimpisa Chomsri","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYDACZiBOADEkGBgfMNggBInSwmzAkAYWY2wmzjoJBjYJorSYs3OnPXjwx46Bf3bzsaobCYcZ+NsPsD8uwKPFspl3u0FiWzKDxJ1jabdzgFokziQwNs/Ao8XgMO82icQGZgYDiRyz27k/DjMw3AA6jIeQloQ/9WAtxSBb5InTwnYYrIUZpMWAkBaoX47zSNxIS5bOSUjnMTyT2DgbnxZz/rPbHv74Uy3HPyP54OecBGs5ueOHD3zG6zAGBjYQDVcDZDA24NGA0DIKRsEoGAWjADcAAPfiRrDFDttkAAAAAElFTkSuQmCC","orcid":"","institution":"Mae Fah Luang University","correspondingAuthor":true,"prefix":"","firstName":"Pimpisa","middleName":"","lastName":"Chomsri","suffix":""},{"id":517231995,"identity":"d22716da-c88e-41a0-ac05-22c29f1f1530","order_by":1,"name":"Surinporn Likhitsathian","email":"","orcid":"","institution":"Chiang Mai University","correspondingAuthor":false,"prefix":"","firstName":"Surinporn","middleName":"","lastName":"Likhitsathian","suffix":""},{"id":517231996,"identity":"06194afa-e2c1-4a82-96b6-d437880ebc6a","order_by":2,"name":"Mullika Matrakul","email":"","orcid":"","institution":"Mae Fah Luang University","correspondingAuthor":false,"prefix":"","firstName":"Mullika","middleName":"","lastName":"Matrakul","suffix":""},{"id":517231997,"identity":"9482d4cc-3f0e-4f2f-b450-42417c0bd237","order_by":3,"name":"Soontaree Suratana","email":"","orcid":"","institution":"Mae Fah Luang University","correspondingAuthor":false,"prefix":"","firstName":"Soontaree","middleName":"","lastName":"Suratana","suffix":""},{"id":517231998,"identity":"4786609f-bcde-4152-b949-48f43abdaeec","order_by":4,"name":"Charoenchai Wongwatkit","email":"","orcid":"","institution":"Mae Fah Luang University","correspondingAuthor":false,"prefix":"","firstName":"Charoenchai","middleName":"","lastName":"Wongwatkit","suffix":""},{"id":517231999,"identity":"aebf1a80-7d32-4077-b43e-9a67ba079856","order_by":5,"name":"Panida Chaiwang","email":"","orcid":"","institution":"Chiang Rai College","correspondingAuthor":false,"prefix":"","firstName":"Panida","middleName":"","lastName":"Chaiwang","suffix":""},{"id":517232000,"identity":"e0c3d8c8-577a-4474-8759-d846a4e0f4a9","order_by":6,"name":"Benyaluk Muddee","email":"","orcid":"","institution":"Chiang Rai College","correspondingAuthor":false,"prefix":"","firstName":"Benyaluk","middleName":"","lastName":"Muddee","suffix":""}],"badges":[],"createdAt":"2025-08-23 07:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7439535/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7439535/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93196792,"identity":"7aee5942-b261-4bd9-b8ba-39e1dbd07188","added_by":"auto","created_at":"2025-10-10 06:00:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":833330,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7439535/v1/8441656a-ecf1-4c68-bf11-f8a883cd84db.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Beyond Prevalence: Understanding Substance Use Behaviors and Associated Risks in Ethnic Minority Students at Primary-Secondary Transition","fulltext":[{"header":"New Contribution to the Literature","content":"\u003cp\u003eThis study makes several key contributions to the literature on youth substance use and minority health. First, it provides novel epidemiological data on a severely under-researched and vulnerable population: ethnic minority children in Northern Thailand during the primary-to-secondary school transition. Second, it moves beyond simple prevalence reporting to uncover a critical public health paradox, demonstrating that low rates of substance use can mask a significant underlying profile of moderate-to-high risk. Third, by empirically identifying male gender, higher grade level, and co-occurring deviant behaviour as strong statistical predictors, this study elucidates the primary mechanisms of risk in this specific context. Finally, these findings provide a crucial, evidence-based foundation for the development of targeted, culturally-sensitive prevention policies aimed at mitigating health disparities in this population.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eSubstance use among children and adolescents continues to be a significant global public health concern. According to the United Nations Office on Drugs and Crime (UNODC), a substantial proportion of individuals initiate substance use during adolescence, with early initiation linked to increased vulnerability to long-term negative outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although prevalence varies by region, the global data highlight adolescence as a high-risk period. In Southeast Asia, the problem is particularly pressing due to the region\u0026rsquo;s complex drug production and trafficking landscape. Studies have reported increasing substance use trends among youth, often driven by socio-economic vulnerabilities, peer influences, and access to substances [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eIn Thailand, national surveys have consistently shown that substance use initiation commonly occurs in early adolescence, with some substances, such as alcohol, tobacco, and kratom, being used at higher rates among younger age groups compared to older adolescents or the general population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This early exposure underscores the need for timely and developmentally appropriate prevention strategies. Research also shows that early initiation of substance use is strongly associated with increased risk of later substance use disorders, poor educational, and cognitive outcomes, and mental health problems such as anxiety and depression [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Moreover, substance use during childhood and adolescence may increase the likelihood of engaging in risky behaviours, criminal activity, and experiencing strained social and familial relationships [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite growing recognition of the adolescent substance use problem in Thailand, limited research has explored this issue in the context of ethnic minority populations, particularly those in the upper primary school years. This developmental stage\u0026mdash;the transition from primary to secondary education\u0026mdash;is a critical period characterized by increasing autonomy, identity exploration, and heightened susceptibility to peer influence [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These factors may contribute to the initiation of risk behaviours, including substance use.\u003c/p\u003e\u003cp\u003eChiang Rai Province, in Northern Thailand near the Golden Triangle, an area known for illicit drug production and trafficking, presents a particularly unique risk environment. The province is home to diverse ethnic minority groups such as the Akha, Lahu, Hmong, and Yao, many of whom live in rural, resource-limited areas and face barriers related to language, access to education, and healthcare services [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These structural and socio-cultural factors may heighten vulnerability to early substance use, yet a lack of empirical research is focused specifically on this population. While some studies have addressed adolescent drug use in Northern Thailand more broadly, few have examined ethnic minority students at the crucial developmental transition between upper primary and lower secondary school.\u003c/p\u003e\u003cp\u003eAddressing this gap is essential for the development of effective, culturally appropriate prevention strategies. A nuanced understanding of the prevalence, patterns, and risk levels of substance use among ethnic minority students can inform interventions that are tailored to their specific socio-cultural and geographic contexts.\u003c/p\u003e\u003cp\u003eTherefore, this study aimed first, to investigate the substance use experiences and to assess the associated risk levels, and second, to explore the association between key environmental and behavioural factors (i.e., parental use, peer use, and deviant behaviour) and substance use among ethnic minority students in the upper primary education level.\u003c/p\u003e\n\u003ch3\u003eConceptual framework\u003c/h3\u003e\n\u003cp\u003eThis study's conceptual framework posits that lifetime substance use initiation among ethnic minority students in Northern Thailand is the outcome of converging risks across demographic, developmental, and behavioural dimensions. These factors are not direct causes but operate through distinct underlying mechanisms: male sex is driven by a bio-sociocultural pathway of slower neurological maturation and gendered social norms; higher grade level operates through a developmental-social pathway of increasing autonomy and peer influence; and deviant behaviour is explained by a shared vulnerability mechanism, suggesting substance use is part of a broader syndrome of externalizing behaviours. The confluence of these pathways creates a heightened state of risk, identifying a specific vulnerable subgroup and explaining how and why substance use initiation emerges in this population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis research employed a cross-sectional survey design to investigate substance use experiences and assess the associated risk levels among ethnic minority students in the upper primary education level at a single point in time.\u003c/p\u003e\n\u003ch3\u003e1. Participants\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation\u003c/strong\u003e\u003cp\u003eThis research targeted all ethnic minority students currently enrolled in Prathom 4 (Grade 4) to Prathom 6 (Grade 6) in schools in Chiang Rai Province.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSample\u003c/strong\u003e\u003cp\u003eDue to the large population size, a sampling method was necessary to obtain a representative sample. The multi-stage sampling process involved three distinct steps. First, two districts within Chiang Rai Province were purposively selected based on their high concentration of ethnic minority populations. Second, a simple random sampling was used to select five schools from the list of all primary schools within these two districts. Finally, all ethnic minority students enrolled in Grades 4 to 6 in the selected schools who met the inclusion criteria were invited to participate in the study. The sample size was based on an appropriate sample size calculation formula for survey research, considering the desired level of confidence and margin of error.\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003e2. Data Collection\u003c/h3\u003e\n\u003cp\u003ePrior to fieldwork, questionnaires and related documents were prepared, and research assistants were trained in data collection procedures, interview techniques, and research ethics. Permission to conduct the research was first secured from school administrators. Subsequently, information sheets and parental consent forms were sent home with the students for their legal guardians to review and sign. Research assistants then held a separate session with the students to explain the study in simple, age-appropriate language, ensuring they understood the purpose of the research and that their participation was completely voluntary. Verbal assent was obtained from each student prior to data collection, in addition to the written informed consent from their guardians. It was emphasized that students could withdraw from the study at any time without any negative consequences.\u003c/p\u003e\u003cp\u003eData were subsequently collected from the student sample at selected schools, where participants completed questionnaires under supervision, with focus group discussions utilized to gather more in-depth information. Following data collection, all data were reviewed for completeness and accuracy, entered into a suitable database, and stored systematically and securely to maintain participant confidentiality.\u003c/p\u003e\n\u003ch3\u003e3. Measures\u003c/h3\u003e\n\u003cp\u003eThe general information questionnaire consisted of items assessing sex, ethnicity, current grade level, parental substance use, close friends' substance use, and engagement in deviant behaviour. The Alcohol, Smoking and Substance Involvement Screening Test-Youth (ASSIST-Y) is a screening tool for youth developed with the support of the World Health Organization (WHO) by a team of addiction researchers and clinicians. It assesses experiences with alcohol consumption, smoking, and substance use. Its reliability has been tested, yielding a Cronbach's alpha of 0.80. The ASSIST-Y yields a Specific Substance Involvement score for each substance category based on responses to questions concerning frequency of use, craving, and related problems. For this study, risk levels were categorized based on the standard scoring protocol developed for youth. Following the established guidelines, scores of 0\u0026ndash;3 were categorized as low risk (indicating a need for health education), scores of 4\u0026ndash;15 as moderate risk (indicating a brief intervention is appropriate), and scores of 16 or higher as high risk (indicating a need for referral to specialist assessment and treatment). [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Deviant behaviour was assessed using a checklist of five items adapted from previous youth risk surveys. Students were asked whether, in the past year, they had engaged in any of the following behaviours: (1) getting into a physical fight, (2) skipping school without permission, (3) lying to parents or guardians, (4) stealing something of value, or (5) intentionally damaging property. A dichotomous variable was created where participants who responded 'yes' to one or more of these items were categorized as 'engaging in deviant behaviours'.\u003c/p\u003e\n\u003ch3\u003e4. Analysis\u003c/h3\u003e\n\u003cp\u003eData were analysed using. Descriptive statistics, including frequencies and percentages, were used to summarize the participants' demographic characteristics, substance use prevalence, and associated risk levels. To explore the mechanisms of risk, chi-square tests of independence were performed to examine the association between various risk factors and lifetime substance use. Fisher's Exact Test was utilized when expected cell counts were less than five. The alpha level for all tests was set at p\u0026thinsp;\u0026lt;\u0026thinsp;.05.\u003c/p\u003e\n\u003ch3\u003e5. A statement indicating ethical review\u003c/h3\u003e\n\u003cp\u003eEthics approval: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. The study was approved by the Research Ethics Committee of Chiang Rai Provincial Public Health Office (Approval code: CRPPHO No. 94/2564).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent to participate: Informed consent to participate in the study was obtained from the legal guardians of all individual participants included in the study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable 1 presents the demographic characteristics of the participants (\u003cem\u003eN\u003c/em\u003e = 186). The sample comprised slightly more females (54.8%, \u003cem\u003en\u003c/em\u003e = 102) than males, with the majority of participants identifying as Hmong (59.7%, \u003cem\u003en\u003c/em\u003e = 111). Regarding environmental factors, more than a quarter of participants (27.4%, \u003cem\u003en\u003c/em\u003e = 51) reported having a parent who used substances, and nearly a quarter (23.1%, \u003cem\u003en\u003c/em\u003e = 43) reported engaging in deviant behaviours. Full demographic details are available in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1\u0026nbsp;Demographic Characteristics of Study Participants (\u003cem\u003en\u0026nbsp;\u003c/em\u003e=\u0026nbsp;186)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e45.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e54.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eEthnicities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Hmong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e59.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Akha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Prathom 4 (Grade 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e37.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Prathom 5 (Grade 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Prathom 6 (Grade 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e35.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eParental substance use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Used substances\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Non-used substances\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e72.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eClose friends\u0026apos; substance use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Used substances\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Non-used substances\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e87.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eDeviant behaviour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Engaging in deviant behaviours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Never engaging in deviant behaviours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e76.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 details the lifetime and past 3-month prevalence of substance use, which was generally low overall. Alcohol and tobacco products were the most common substances reported for lifetime use, at 8.6% (\u003cem\u003en\u003c/em\u003e = 16) and 5.9% (\u003cem\u003en\u003c/em\u003e = 11), respectively. This pattern persisted for past 3-month use, where alcohol (7.0%, \u003cem\u003en\u003c/em\u003e = 13) and tobacco (2.7%, \u003cem\u003en\u003c/em\u003e = 5) remained the most frequently used substances. The prevalence for all other substances was considerably lower, with zero reported use of heroin, tranquilizers, or hallucinogens in the past three months. Specific prevalence rates for each substance are shown in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Prevalence of Lifetime and Past Three-Month Substance Use Among Participants.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubstances\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 472px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLifetime substance use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePast 3-month substance use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTobacco products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e11 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e5 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e16 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e13 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCannabis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e7 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAmphetamine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eGlue/thinner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e4 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eKratom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e6 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e2 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHeroin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTranquilizers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHallucinogens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eOther substances\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e4 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 displays the distribution of all participants across risk levels associated with past 3-month substance use. For alcohol, the most commonly used substance, the majority of the sample was classified as low risk (81.2%, \u003cem\u003en\u003c/em\u003e = 151). However, a different pattern emerged for most other substances, where the majority of the sample was categorized as being at a moderate risk, including for tobacco (96.8%), cannabis (96.8%), and amphetamine (97.8%). Of particular concern, despite very low prevalence rates, a small number of individuals were classified as high risk for use of tranquilizers (3.8%, \u003cem\u003en\u003c/em\u003e = 7), heroin (3.2%, \u003cem\u003en\u003c/em\u003e = 6), and other substances (3.8%, \u003cem\u003en\u003c/em\u003e = 7). This indicates the presence of a highly vulnerable subgroup, as detailed in Table 3.\u003c/p\u003e\n\u003cp id=\"_Toc115356622\"\u003e\u003cstrong\u003eTable 3 Distribution of Participants (\u003c/strong\u003e\u003cem\u003en\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;= 186) Across Different Levels of Risk Associated with Their Substance Use in the Past Three Months\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubstances\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk levels associated with past 3-month substance use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eTobacco Products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e180 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e151 (81.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e32 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eCannabis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e180 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAmphetamine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e182 (97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e2 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eGlue/Thinner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e182 (97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e2 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eKratom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e181 (97.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHeroin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e177 (95.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e6 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eTranquilizers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e176 (94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e7 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHallucinogens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e182 (97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOther substances\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e176 (94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e7 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4 presents the results of the Chi-square tests examining the association between demographic, environmental, and behavioural factors and lifetime substance use. The analysis revealed that several factors were significantly associated with substance use. A highly significant association was found between sex and substance use (\u0026chi;\u0026sup2; = 12.545, p = .001), with male students representing a much larger proportion of substance users than female students. Furthermore, education level was also significantly associated with substance use (\u0026chi;\u0026sup2; = 7.840, p = .020), indicating that students in higher grades, particularly Grade 6, were more likely to have used substances. The most critical behavioural factor was deviant behaviour, which showed a highly significant association with substance use (\u0026chi;\u0026sup2; = 9.046, p = .003). Students who engaged in deviant behaviours were substantially more likely to be substance users compared to those who did not.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003eRelationship Between Demographic, Environmental, and Behavioural Factors and Lifetime Substance Use\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLifetime substance use\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e12.545\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e72 (41.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e12 (92.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e101 (58.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1 (7.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.228\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.541\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Hmong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e104 (60.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7 (53.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Akha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e32 (18.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4 (30.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e37 (21.39X\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2 (15.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.840\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.020*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Prathom 4 (Grade 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e68 (39.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1 (7.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Prathom 5 (Grade 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e48 (27.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (23.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Prathom 6 (Grade 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e57 (32.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (69.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParental substance use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e.079\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.754\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e47 (27.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4 (30.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e126 (72.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (69.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClose friends\u0026apos; substance use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.368\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e19 (10.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4 (30.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e154 (89.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (69.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeviant behaviour\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9.046\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.003**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e72 (41.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11 (84.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e101 (58.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2 (15.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p-value\u0026lt;.05, ** p-value\u0026lt;.01\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Fisher\u0026rsquo;s Exact Test\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides a nuanced understanding of substance use among ethnic minority students during the critical primary-to-secondary school transition in a high-risk region of Northern Thailand. The findings reveal two central insights. First, while the overall prevalence of substance use is currently low, the pattern of use is consistent with established literature, showing alcohol and tobacco as the primary \u0026quot;gateway\u0026quot; substances for this young population [10, 11]. Second, and more critically, this study uncovers a concerning paradox: despite low prevalence rates, the majority of young users are classified at a moderate-risk level, with a small but significant subgroup identified as high risk for severe substances like heroin and tranquilizers.\u0026nbsp;This study transitioned from a descriptive prevalence survey to an analytical exploration of the mechanisms underlying substance use initiation among ethnic minority students in Northern Thailand. By analysing key risk factors, our findings identify specific, vulnerable subgroups and offer a clearer understanding of why risk emerges in this population. The discussion now centres on the three factors that demonstrated a significant statistical association with lifetime substance use: sex, education level, and deviant behaviour.\u003c/p\u003e\n\u003cp\u003eThe most pronounced finding was the strong association between sex and substance use, with male students accounting for over 90% of users. This aligns with global epidemiological data but our study suggests the mechanisms are already at play in late childhood. Recent research posits that this gender disparity is driven by a convergence of neurobiological and sociocultural factors. Boys, on average, exhibit a slower maturation of the prefrontal cortex, which governs impulse control, making them more susceptible to risk-taking behaviours [12]. Concurrently, sociocultural norms often equate masculinity with experimentation and resilience in the face of risk, creating an environment where substance use initiation is perceived as a normative part of male social development [13]. Thus, the mechanism is likely a dual pathway of heightened biological propensity and social reinforcement.\u003c/p\u003e\n\u003cp\u003eOur analysis also revealed a significant relationship between education level and substance use, with a clear concentration of users in Grade 6. This finding highlights the primary-to-secondary school transition as a critical window of vulnerability. The mechanism here is developmental; as students progress to the final year of primary school, they experience a sharp increase in autonomy, decreased parental supervision, and a fundamental shift in their social worlds [14]. The desire for social acceptance intensifies, and peer groups become the dominant socializing force. For students in Grade 6, substance use may serve as a social tool to signal maturity or gain entry into desired peer groups as they anticipate the move to secondary school, a period known for increased risk exposure [15].\u003c/p\u003e\n\u003cp\u003ePerhaps the most compelling finding is the powerful association between deviant behaviour and substance use, where students exhibiting such behaviours comprised nearly 85% of all users. This provides strong evidence for a \u0026quot;shared vulnerability\u0026quot; or \u0026quot;common liability\u0026quot; mechanism in this population. Rather than viewing substance use as an isolated act, this finding suggests it is part of a broader syndrome of externalizing behaviours [16]. The underlying mechanism posits that a common set of factors\u0026mdash;such as temperamental traits like poor impulse control, sensation-seeking, and exposure to adverse environments\u0026mdash;predisposes certain children to a range of problem behaviours, including aggression, defiance, and substance use initiation [17, 18]. Therefore, early substance use in our sample appears to be a symptom of a more general difficulty with behavioural regulation, not simply a standalone choice.\u003c/p\u003e\n\u003cp\u003eInterestingly, factors such as parental and close friends\u0026apos; substance use did not demonstrate a statistically significant relationship in this analysis, contrary to much of the established literature. This may be due to several factors, including statistical power limitations given the small number of users in the sample, or the possibility that social influence at this age is more subtle than what can be captured by a direct \u0026apos;yes/no\u0026apos; question. Nonetheless, the clear significance of the other factors provides a robust model for understanding risk.\u003c/p\u003e\n\u003cp\u003eThis deeper, mechanism-focused analysis allows for a more targeted approach to prevention. The \u0026quot;window of opportunity\u0026quot; identified previously can now be specified: intervention efforts should be prioritized for male students, particularly as they approach Grade 6, and especially for those who exhibit early signs of externalizing or deviant behaviours. Prevention programs should be tailored to address the underlying mechanisms, such as by incorporating gender-sensitive modules that challenge risky social norms for boys and by focusing on building general self-regulation and social-emotional skills for children with conduct problems [12]. By understanding and targeting the why behind the risk, we can move beyond prevalence to implement truly effective, evidence-based prevention for this vulnerable population.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; This research, while providing valuable insights, has certain limitations. A significant limitation of this study is the application of the ASSIST-Y and its standard risk categories to a population younger than its primary validation range. While the ASSIST-Y is designed for adolescents, its specific scoring cutoffs for \u0026apos;moderate\u0026apos; and \u0026apos;high\u0026apos; risk have not been formally validated for children aged 9-12 or specifically for ethnic minority populations in Thailand. Therefore, the interpretation of these risk levels should be approached with caution, as the clinical meaning of a \u0026apos;moderate\u0026apos; risk score in a 10-year-old may differ from that in a 16-year-old. Future research is critically needed to validate substance use screening tools and establish developmentally appropriate risk thresholds for this specific age and cultural context. The cross-sectional design precludes the establishment of temporal relationships between risk factors and substance use. Furthermore, reliance on self-reported data may be subject to recall and social desirability biases. However, the study\u0026apos;s strength lies in its focus on an under-researched and highly vulnerable population in a key geographical region, contributing vital data to the field. Future research should employ longitudinal designs to track the developmental trajectories of substance use in this cohort as they are exposed to increasing risk factors in adolescence [6]. Qualitative studies are also essential to gain a richer contextual understanding of the socio-cultural factors influencing these behaviours and to inform the development of more effective, culturally-adapted interventions.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConsent to participate:\u003c/h2\u003e\u003cp\u003e Informed consent to participate in the study was obtained from the legal guardians of all individual participants included in the study.\u003c/p\u003e\u003ch2\u003eFunding Declaration\u003c/h2\u003e\u003cp\u003eThis work was supported by the National Research Council of Thailand (NRCT); and the Centre of Excellence for the Hill Tribe Health Research and Training, Mae Fah Luang University. Partial financial support was also received from Chiang Mai University. The funding sources had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEach author certifies that their contribution to this work meets the standards of the International Committee of Medical Journal Editors.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThis study was accomplished with the support of all relevant sectors. This research project has been funded by the National Research Council of Thailand (NRCT) and the Center of Excellence for the Hill Tribe Health Research and Training, Mae Fah Luang University, Chiang Rai, Thailand. This research was partially supported by Chiang Mai University.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUnited Nations Office on Drugs and Crime. World drug report 20232023.\u003c/li\u003e\n\u003cli\u003eASEAN Training Center for Preventive Drug Education. Youth and substance use in Southeast Asia: Emerging trends and responses.2021.\u003c/li\u003e\n\u003cli\u003eOffice of the Narcotics Control Board. National report on drug situation in Thailand 20222022.\u003c/li\u003e\n\u003cli\u003eSqueglia LM, Jacobus J, Tapert SF. The influence of substance use on adolescent brain development. Clin EEG Neurosci. 2009;40(1):31-8.\u003c/li\u003e\n\u003cli\u003eFergusson DM, Boden JM. Cannabis use and later life outcomes. Addiction. 2008;103(6):969-76; discussion 77-8.\u003c/li\u003e\n\u003cli\u003eSteinberg L. A Social Neuroscience Perspective on Adolescent Risk-Taking. Dev Rev. 2008;28(1):78-106.\u003c/li\u003e\n\u003cli\u003eWongphanit N, Tanskul S, Maneepong C. Ethnic minority education and health service accessibility in northern Thailand: Challenges and opportunities. . Journal of Population and Social Studies. 2018;26:101-15.\u003c/li\u003e\n\u003cli\u003eInternational Crisis Group. Thailand: The evolving conflict in the south. Asia Report No. 241 2010.\u003c/li\u003e\n\u003cli\u003eDrug and Alcohol Services South Australia. Instruction for Clinicians: How to administer the ASSIST-Y and linked Intervention to young people aged 15-17 years. South Australia: Drug and Alcohol Services South Australia 2011.\u003c/li\u003e\n\u003cli\u003eKandel DB, Yamaguchi K, Chen K. Stages of progression in drug involvement from adolescence to adulthood: further evidence for the gateway theory. Journal of studies on alcohol. 1992;53(5):447-57.\u003c/li\u003e\n\u003cli\u003eNational Institute on Drug Abuse. Monitoring the Future 2023 Survey Results: Trends in adolescent drug use2023 May 24, 2025.\u003c/li\u003e\n\u003cli\u003eAnderberg M, Dahlberg M. Gender differences among adolescents with substance abuse problems at Maria clinics in Sweden. Nordic Studies on Alcohol and Drugs. 2018;35(1):24-38.\u003c/li\u003e\n\u003cli\u003eStewart R, Wright B, Smith L, Roberts S, Russell N. Gendered stereotypes and norms: A systematic review of interventions designed to shift attitudes and behaviour. Heliyon. 2021;7(4):e06660.\u003c/li\u003e\n\u003cli\u003eDeCamp W, Bakken N. Transitioning to Middle School in the Sixth Grade: A Hierarchical Linear Modeling (HLM) Analysis of Substance Use, Violence, and Suicidal Thoughts. Journal of Early Adolescence - J EARLY ADOLESCENCE. 2010;30:895-915.\u003c/li\u003e\n\u003cli\u003eLetina S, Long E, McCrorie P, Mitchell K, Zucca C, Riddell J, et al. Cross-sectional social network study of adolescent peer group variation in substance use and mental wellbeing: The importance of the meso level. Social Networks. 2024;78:119-37.\u003c/li\u003e\n\u003cli\u003eK\u0026ouml;ck P, Meyer M, Elsner J, D\u0026uuml;rsteler KM, Vogel M, Walter M. Co-occurring Mental Disorders in Transitional Aged Youth With Substance Use Disorders \u0026ndash; A Narrative Review. Frontiers in Psychiatry. 2022;Volume 13 - 2022.\u003c/li\u003e\n\u003cli\u003eGaron-Carrier G, Pascuzzo K, Gaudreau W, Lemelin J-P, D\u0026eacute;ry M. Maternal Functioning and Child\u0026apos;s Externalizing Problems: Temperament and Sex-Based Driven Effects. Frontiers in Psychology. 2022;Volume 13 - 2022.\u003c/li\u003e\n\u003cli\u003eBrieant A, King-Casas B, Kim-Spoon J. Transactional relations between developmental trajectories of executive functioning and internalizing and externalizing symptomatology in adolescence. Development and psychopathology. 2022;34(1):213-24.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-immigrant-and-minority-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joih","sideBox":"Learn more about [Journal of Immigrant and Minority Health](http://link.springer.com/journal/10903)","snPcode":"10903","submissionUrl":"https://submission.springernature.com/new-submission/10903/3","title":"Journal of Immigrant and Minority Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"substance use, ethnic minority, adolescents, Thailand","lastPublishedDoi":"10.21203/rs.3.rs-7439535/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7439535/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eResearch on substance use among ethnic minority students during the critical primary-to-secondary school transition in Northern Thailand remains limited. This study investigated substance use experiences, associated risks, and key demographic and behavioural factors in this vulnerable population. A cross-sectional study was conducted with 186 ethnic minority students (Grades 4\u0026ndash;6) in Chiang Rai, Thailand, using the Alcohol, Smoking and Substance Involvement Screening Test-Youth (ASSIST-Y). Data were analysed using descriptive statistics and chi-square tests. Lifetime substance use prevalence was low (e.g., alcohol 8.6%, tobacco 5.9%), yet most users were classified at a moderate-risk level. Lifetime use was significantly associated with being male (χ\u0026sup2;=12.545, p\u0026thinsp;=\u0026thinsp;.001), being in a higher grade level (χ\u0026sup2;=7.840, p\u0026thinsp;=\u0026thinsp;.020), and exhibiting deviant behaviour (χ\u0026sup2;=9.046, p\u0026thinsp;=\u0026thinsp;.003). Despite low prevalence, a concerning profile of moderate-to-high risk exists. The findings identify a vulnerable subgroup (males, older students, and those with behavioural issues), highlighting the need for targeted, gender-sensitive prevention programs during this critical school transition.\u003c/p\u003e","manuscriptTitle":"Beyond Prevalence: Understanding Substance Use Behaviors and Associated Risks in Ethnic Minority Students at Primary-Secondary Transition","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-10 05:52:05","doi":"10.21203/rs.3.rs-7439535/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-18T17:03:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T06:58:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-03T06:57:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Immigrant and Minority Health","date":"2025-08-23T07:38:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-immigrant-and-minority-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joih","sideBox":"Learn more about [Journal of Immigrant and Minority Health](http://link.springer.com/journal/10903)","snPcode":"10903","submissionUrl":"https://submission.springernature.com/new-submission/10903/3","title":"Journal of Immigrant and Minority Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9a6a30b6-b779-470c-8ffd-12d4ca532574","owner":[],"postedDate":"October 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T16:53:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-10 05:52:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7439535","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7439535","identity":"rs-7439535","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}