{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:30:47Z","timestamp":1792024247770,"version":"4.4.0"},"reference-count":93,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Adolescent substance use is a growing public health concern in Africa, yet little is known about the contextual factors of substance use among young African populations. This systematic review identified factors associated with substance use among adolescents (aged 10\u201319\u2009years) in Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This review was conducted in line with PRISMA guidelines. We searched six databases (from January 2000 to December 2020): PubMed, Cochrane Library, African Journals Online (AJOL), Google Scholar, ScienceDirect and World Health Organization (WHO) African Index Medicus. We included population\u2010based observational studies reporting on factors associated with adolescent substance use across Africa. Study screening was conducted by at least four independent reviewers who resolved discrepancies through discussion and consensus. All included studies were analysed in a narrative synthesis. Studies providing sufficient statistics, i.e. three or more reporting the same outcome and exposure\/predictor, were included in meta\u2010analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty\u2010three peer reviewed studies that were full text accessible were included. The majority were cross\u2010sectional surveys. Factors associated with adolescent substance use identified were linked to individual, family, socioenvironmental and non\u2010familial social networks determinants. Results from both the narrative synthesis and meta\u2010analysis revealed that being male and an older adolescent were significantly associated with adolescent substance use. Combined odds ratio (OR) of males who currently smoke compared with females was 1.81 [95% confidence interval (CI) = 1.37\u20132.39; 6 studies, 13\u2009443 participants, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u200959.67%]. Additional meta\u2010analysis outcomes found that having a friend who smokes was associated with tobacco smoking. Combined OR of \u2018ever\u2010smokers\u2019 with a friend who smoked was 4.83 (CI = 2.56\u20139.10; 3 studies, 18\u2009858 participants, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u200979.21%). Having a family member who smokes was associated with smoking initiation (OR = 2.99; CI = 2.67\u20133.35; 3 studies, 18\u2009858 participants, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u20090%) and current smoking (OR = 2.33; CI = 2.23\u20132.45; 4 studies, 13\u2009282 participants, I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u20090%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multiple factors that operate on individual, family and societal levels influence adolescent substance use in Africa. Key factors of adolescent substance use in Africa appear to include being male, being an older adolescent and being exposed to peer substance use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70023","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T01:25:10Z","timestamp":1741742710000},"page":"1127-1142","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["A systematic review and meta\u2010analysis of factors associated with adolescent substance use in Africa, 2000 to 2020"],"prefix":"10.1111","volume":"120","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6624-1689","authenticated-orcid":false,"given":"Sandra","family":"Jumbe","sequence":"first","affiliation":[{"name":"School of Social and Health Sciences Millennium University  Blantyre Malawi"},{"name":"Centre for Evaluation and Methods, Wolfson Institute of Population Health Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Mwenda Kamninga","sequence":"additional","affiliation":[{"name":"School of Social and Health Sciences Millennium University  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ukwuori\u2010Gisela","family":"Kalu","sequence":"additional","affiliation":[{"name":"School of Social and Health Sciences Millennium University  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Nyali","sequence":"additional","affiliation":[{"name":"School of Social and Health Sciences Millennium University  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Saleh","sequence":"additional","affiliation":[{"name":"Centre for Evaluation and Methods, Wolfson Institute of Population Health Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Newby","sequence":"additional","affiliation":[{"name":"The Medical School University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1902-2683","authenticated-orcid":false,"given":"Joel Msafiri","family":"Francis","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Primary Care, Faculty of Health Sciences University of Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Adolescent health","author":"World Health Organisation","year":"2015"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature16030"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60512-6"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2011.03751.x"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(16)00013-4"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-010-9146-6"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30303-6"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.7196\/SAJCH.2018.v12i2b.1524"},{"issue":"2","key":"e_1_2_11_10_1","first-page":"97","article-title":"Context and consequences of liquor sachets use among young people in Malawi","volume":"13","author":"Hoel E","year":"2014","journal-title":"Afr J Drug Alcohol Stud"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jana.2015.07.003"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-660"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1515\/ijamh-2015-0096"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-018-1780-1"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.4314\/ajpsy.v13i1.53430"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13011-018-0163-4"},{"key":"e_1_2_11_17_1","unstructured":"NgBessie KJKalra\u2010RamjooShanonUnderstanding the determinants of substance misuse: a rapid review2018"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-475X.2004.04006.x"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-021-01680-y"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_2_11_21_1","unstructured":"World Health Organisation. 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