{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:12:27Z","timestamp":1792807947861,"version":"4.5.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T00:00:00Z","timestamp":1689811200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"Background<\/jats:title>Adolescent use of substances and injury experiences such as head injury have become increasingly prevalent. However, information regarding their association and the potential pathways linking them remains limited. This study examined the association between substance use and injuries, emphasizing the mediating role of interpersonal violence among adolescents.<\/jats:p><\/jats:sec>Methods<\/jats:title>We employed a multi-country analysis of Global School-based Health Surveys of 122,945 in-school adolescents aged 11\u201318 from 29 countries. This study was a cross-sectional school-based, nationally representative study developed by the World Health Organization and the United States Centers for Disease Control and Prevention, other United Nations allies, and country-specific institutions. Random-effects meta-analysis was performed to estimate the overall prevalence of injury and substance use and the I-square (I<\/mml:mi>2<\/mml:mn><\/mml:msup>)<\/mml:mo><\/mml:mrow><\/mml:math><\/jats:inline-formula> statistic was used to investigate the between-country heterogeneity. Logistic regression models were fitted to examine the association between substance use and injuries. A path analysis was used to examine the potential mediation effect of interpersonal violence and employed decomposition of effects into total, direct, and indirect.<\/jats:p><\/jats:sec>Results<\/jats:title>Prevalence of substance use and injuries were 33.6% (95%CI\u2009=\u200928.5, 38.6%) and 41.7% (95%CI\u2009=\u200937.3, 46.1%), respectively. Substance use (37.8% vs. 29.4%, p<\/jats:italic>\u2009=\u20090.001) and injuries (47.3% vs. 36.4%, p<\/jats:italic>\u2009=\u20090.001) were significantly higher among male adolescents than females, respectively. After adjustment, substance users had 40% higher odds of injuries. The path analysis showed a mediation effect of perpetration of and victimization by interpersonal violence on the association of substance use with injuries, with total positive effects of perpetration [\u03b2\u2009=<\/jats:italic> 0.18; 95%CI\u2009=\u20090.16, 0.19; p<\/jats:italic>\u2009=\u20090.001] and victimization on injuries [\u03b2\u2009=<\/jats:italic> 0.22; 95%CI\u2009=\u20090.21, 0.24; p<\/jats:italic>\u2009=\u20090.001]. In a further subgroup analysis, tobacco users were 3.98 times more likely to sustain a gunshot wound whiles marijuana users had 2.81 times higher odds of sustaining gunshot wounds. Cigarette smokers had 45% lower odds of sustaining cut\/stab wounds. Alcohol users were 53% more likely to sustain concussion\/head injury and two and half times more likely to sustain gunshot wound.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>A significant association exists between substance use and severe injuries among adolescents, mediated by interpersonal violence exposure. Our findings may have utility in informing substance use and interpersonal violence control policies and interventions to address adolescent injuries.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1193711","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T22:32:46Z","timestamp":1689892366000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Substance use and adolescent injuries: a multi-country analysis of the association and mediating effect of interpersonal violence among 122,945 in-school paediatric populations in 29 countries"],"prefix":"10.3389","volume":"11","author":[{"given":"Benjamin 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pandemic","year":"2021"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/S2352-4642(20)30390-4","article-title":"Prevalence and trends in tobacco use among adolescents aged 13\u201315 years in 143 countries, 1999\u20132018: findings from the global youth tobacco surveys","volume":"5","author":"Ma","year":"2021","journal-title":"Lancet Child Adolesc Health"},{"key":"ref5","volume-title":"Drug and substance use in adolescents","author":"Levy","year":"2022"},{"key":"ref6","author":"Johnston","year":"2021"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"315","DOI":"10.14303\/er.2014.226","article-title":"Substance abuse among public secondary school students: prevalence, strategies and challenges for public secondary school managers in Kenya: a case study of Kisumu east Sub County","volume":"5","author":"Simatwa","year":"2014","journal-title":"Educ Res"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2851","DOI":"10.3390\/ijerph9082851","article-title":"Injury and social correlates among in-school adolescents in four southeast Asian countries","volume":"9","author":"Peltzer","year":"2012","journal-title":"Int J Environ Res Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1186\/s12889-022-13198-6","article-title":"Prevalence and psychosocial factors associated with serious injuries among in-school adolescents in eight sub-Saharan African countries","volume":"22","author":"Aboagye","year":"2022","journal-title":"BMC Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/S0376-8716(03)00202-3","article-title":"Injury risk associated with cannabis and cocaine use","volume":"72","author":"Macdonald","year":"2003","journal-title":"Drug Alcohol Depend"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"E21","DOI":"10.1097\/HTR.0b013e31825360da","article-title":"Self-reported traumatic brain injury and post-concussion symptoms in incarcerated youth","volume":"27","author":"Davies","year":"2012","journal-title":"J Head Trauma Rehabil"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.drugalcdep.2005.08.017","article-title":"Illicit drug use and injuries: a review of emergency room studies","volume":"82","author":"Vitale","year":"2006","journal-title":"Drug Alcohol Depend"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1097\/HTR.0b013e31828f9876","article-title":"Traumatic brain injury, mental health, substance use, and offending among incarcerated young people","volume":"29","author":"Moore","year":"2014","journal-title":"J Head Trauma 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Epidemiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"197","DOI":"10.2989\/17280583.2017.1377716","article-title":"Prevalence, demographic and psychosocial correlates for school truancy among students aged 13\u201315 in the Association of Southeast Asian Nations (ASEAN) member states","volume":"29","author":"Pengpid","year":"2017","journal-title":"J Child Adolesc Ment Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1080\/14330237.2017.1409481","article-title":"Parental involvement and health risk behaviours among school-going adolescents in six African countries","volume":"28","author":"Pengpid","year":"2018","journal-title":"J Psychol Afr"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.ssmph.2017.05.005","article-title":"The prevalence and correlates of suicidal behaviours (ideation, plan and attempt) among adolescents in senior high schools in 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Methods"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1177\/1010539519825600","article-title":"Prevalence and correlates of interpersonal violence among in-school adolescents in Sri Lanka: results from the 2016 Sri Lankan global school-based health survey","volume":"31","author":"Senanayake","year":"2019","journal-title":"Asia Pac J Public Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1515\/ijamh-2013-0508","article-title":"Heavy internet use and its associations with health risk and health-promoting behaviours among Thai university students","volume":"26","author":"Peltzer","year":"2014","journal-title":"Int J Adolesc Med Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1007\/s11121-008-0109-6","article-title":"A general model for testing mediation and moderation effects","volume":"10","author":"Fairchild","year":"2009","journal-title":"Prev 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