{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:35:58Z","timestamp":1791837358360,"version":"4.3.4"},"reference-count":48,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Substance use among university students in Ghana is a pressing concern, with pronounced sex differences yet poorly characterised determinants. This study examined factors associated with lifetime alcohol, tobacco and cannabis use among undergraduate students, with explicit attention to sex\u2010specific patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross\u2010sectional study was conducted from January to March 2023 at the University for Development Studies, Tamale. A total of 600 undergraduate students were recruited using quota sampling proportional to school, year and sex, followed by simple random selection (response rate 100%). Lifetime use was defined as self\u2010reported use of each substance at least once, measured using an adapted World Health Organization (WHO) Student Drug Use Survey. Sex\u2010stratified modified Poisson regression with robust standard errors estimated prevalence rate ratios (aPRRs) and 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Lifetime prevalence was 17.7% for alcohol, 17.0% for tobacco and 16.7% for cannabis. Males reported higher use across all substances (alcohol: 31.1%; tobacco: 30.6%; cannabis: 27.4%) than females (11.3%, 10.6%, 11.6%). In the total sample, male sex (aPRR 2.01), older age (&gt;24 years) (1.85) and peer or family drug history (1.41\u20131.48) predicted higher alcohol use, whereas Islamic faith (0.59) and residing at a friend's house (0.49) were protective. Male sex (3.12) and non\u2010Christian religion (3.28) predicted tobacco use. Male sex (2.56) was the only pooled predictor of cannabis use. Sex\u2010stratified analyses revealed distinct patterns: strict parental supervision and absence of family conflict protected males against alcohol use; Islamic faith protected females; residential autonomy and persistent family conflict were female\u2010specific cannabis risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sex differences profoundly shape substance use among university students in Ghana. Religion, parental oversight and family dynamics are key protective or risk factors that differ by sex. Prevention strategies must be sex\u2010sensitive and culturally grounded.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/puh2.70250","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T15:13:59Z","timestamp":1777302839000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sex Differences in the Factors Associated With Lifetime Alcohol, Tobacco and Cannabis Use Among Ghanaian University Students: A Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1223-1765","authenticated-orcid":false,"given":"Yula","family":"Salifu","sequence":"first","affiliation":[{"name":"Department of Population Family and Reproductive Health School of Public Health University of Ghana, Legon  Accra Ghana"},{"name":"Department of Population and Reproductive Health School of Public Health University for Development Studies  Tamale Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Lasong","sequence":"additional","affiliation":[{"name":"Department of Population and Reproductive Health School of Public Health University for Development Studies  Tamale Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4102-4995","authenticated-orcid":false,"given":"Amidu","family":"Alhassan","sequence":"additional","affiliation":[{"name":"Department of Adult Health School of Nursing and Midwifery University of Cape Coast  Cape Coast Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank Offei","family":"Odonkor","sequence":"additional","affiliation":[{"name":"Department of Adult Health School of Nursing and Midwifery University of Cape Coast  Cape Coast Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torjim","family":"Salifu","sequence":"additional","affiliation":[{"name":"Department of Population and Reproductive Health School of Public Health University for Development Studies  Tamale Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders","author":"World Health Organization","year":"2024"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2024.1328318"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40359-022-00987-2"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-693"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0899-3289(01)00098-0"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1516-44462005000300006"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sciaf.2024.e02250"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1747-597X-9-45"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40609-023-00309-3"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13011-024-00600-2"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/09595230600741339"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/19371918.2013.759005"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuropharm.2021.108518"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.4103\/2008-7802.157661"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.26719\/emhj.22.001"},{"key":"e_1_2_13_17_1","first-page":"769","article-title":"Substance Use Among High School\u2010Going Adolescents, Northern Region, Ghana","volume":"6","author":"Mohammed A. 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