{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T10:07:33Z","timestamp":1758190053808,"version":"3.44.0"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"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":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Adolescent substance use (alcohol, tobacco, e-cigarette, marijuana, and other illegal drug use) is a growing public health concern in Latin America. In Central America, Costa Rica consistently reports among the greatest rates of alcohol and marijuana use among secondary school students in the region. However, nationally representative, peer-reviewed studies examining prevalence and etiologic factors remain scarce. This study aimed to examine the prevalence, distribution and associated etiological factors of substance use among Costa Rican adolescents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed data from the 2021 VI National Survey on Psychoactive Substance Use in the Secondary School Population, a cross-sectional, nationally representative survey of 3,524 students (weighted <jats:italic>N<\/jats:italic>\u202f\u2248\u202f354,330) aged 11\u201320\u202fyears. We described the lifetime prevalence of alcohol, tobacco, e-cigarette, marijuana, and other illegal drug use and examined associations with sociodemographic, familial, and emotional distress variables using multivariate logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Alcohol was the most commonly used substance (55.9%), followed by e-cigarettes (13.3%), tobacco (9.8%), other illegal drugs (7.4%), and marijuana (7.2%). Substance use was associated with older age, higher weekly allowance, working while studying, and family substance use. Emotional distress indicators\u2014loneliness, sadness, and suicidal thoughts\u2014were significantly associated with alcohol, tobacco, and other illegal drug use. Parental school monitoring was protective against alcohol use. Notably, e-cigarette use was inversely associated with suicidal thoughts and family smoking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is the first peer-reviewed study to report nationally representative estimates of adolescent substance use in Costa Rica. Findings underscore the multifactorial etiology of substance use and highlight the need for culturally tailored, evidence-based prevention interventions in Costa Rica and Central America.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1655355","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T05:44:26Z","timestamp":1758087866000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Adolescent substance use in Costa Rica: findings from a national survey among secondary school students"],"prefix":"10.3389","volume":"13","author":[{"given":"Pablo","family":"Montero-Zamora","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Lopez-Soto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeancarlo","family":"Cordoba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esmeralda","family":"Ramirez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"ref1","year":"2025"},{"key":"ref2","year":"2019"},{"key":"ref3","year":"2018"},{"key":"ref4","year":"2017"},{"key":"ref5","year":"2017"},{"key":"ref6","year":"2017"},{"key":"ref7","year":"2021"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"638","DOI":"10.15288\/jsa.1997.58.638","article-title":"Age of first use: its reliability and predictive utility","volume":"58","author":"Labouvie","year":"1997","journal-title":"J Stud Alcohol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.drugpo.2014.07.001","article-title":"Age at first use of alcohol predicts the risk of heavy alcohol use in early adulthood: a longitudinal study in the United States","volume":"26","author":"Liang","year":"2015","journal-title":"Int J Drug Policy"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1176\/appi.ajp.162.6.1118","article-title":"The association of early adolescent problem behavior with adult psychopathology","volume":"162","author":"McGue","year":"2005","journal-title":"Am J Psychiatry"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1017\/S0954579499002370","article-title":"The onset of marijuana use from preadolescence and early adolescence to young adulthood","volume":"11","author":"Brook","year":"1999","journal-title":"Dev Psychopathol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1037\/0893-164X.17.2.151","article-title":"Relation between childhood disruptive behavior disorders and substance use and dependence symptoms in young adulthood: individuals with symptoms of attention-deficit\/hyperactivity disorder are uniquely at risk","volume":"17","author":"Flory","year":"2003","journal-title":"Psychol Addict Behav"},{"key":"ref13","volume-title":"A focus on adolescent substance use in Europe, Central Asia and Canada","author":"Charrier","year":"2024"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1186\/s12889-017-4635-7","article-title":"Adolescent alcohol use and parental and adolescent socioeconomic position in six European cities","volume":"17","author":"Bosque-Prous","year":"2017","journal-title":"BMC Public Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1080\/08897077.2013.776000","article-title":"Prevalence and sociodemographic correlates of lifetime substance use among a rural and diverse sample of adolescents","volume":"34","author":"McDermott","year":"2013","journal-title":"Subst Abuse"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.acap.2011.05.005","article-title":"The impact of peer social networks on adolescent alcohol use initiation","volume":"11","author":"Mundt","year":"2011","journal-title":"Acad Pediatr"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1037\/fam0000350","article-title":"Influence of parent\u2013youth relationship, parental monitoring, and parent substance use on adolescent substance use onset","volume":"32","author":"Rusby","year":"2018","journal-title":"J Fam Psychol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1080\/1067828X.2017.1306471","article-title":"What does parental involvement mean in preventing adolescents\u2019 use of alcohol? An integrative review","volume":"26","author":"Mynttinen","year":"2017","journal-title":"J Child Adolesc Subst Abuse"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.abrep.2017.07.003","article-title":"The direct and indirect effect of loneliness on the development of adolescent alcohol use in the United Kingdom","volume":"6","author":"McKay","year":"2017","journal-title":"Addict Behav Rep"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1080\/13548506.2017.1300669","article-title":"The association between adolescent risk behaviours and feelings of sadness or hopelessness: a cross-sectional survey of south African secondary school learners","volume":"22","author":"James","year":"2017","journal-title":"Psychol Health Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1001\/jamapediatrics.2023.6263","article-title":"Substance use, suicidal thoughts, and psychiatric comorbidities among high school students","volume":"178","author":"Tervo-Clemmens","year":"2024","journal-title":"JAMA Pediatr"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"107226","DOI":"10.1016\/j.childyouth.2023.107226","article-title":"Prevalence and potential etiology of youth substance use in Costa Rica: findings from the third National Youth Survey","volume":"155","author":"Montero-Zamora","year":"2023","journal-title":"Child Youth Serv Rev"},{"key":"ref23","year":"2023"},{"key":"ref24","doi-asserted-by":"crossref","DOI":"10.4135\/9781412963947","volume-title":"Encyclopedia of survey research methods","author":"Lavrakas","year":"2008"},{"key":"ref25","doi-asserted-by":"crossref","DOI":"10.1002\/9781118445112.stat03346.pub2","volume-title":"Probability proportional to size (PPS) sampling","author":"Skinner","year":"2016"},{"key":"ref26","doi-asserted-by":"crossref","DOI":"10.4324\/9781003468967-1","article-title":"Introduction: Culture matters! Changes in the global landscape of cannabis","volume-title":"Cannabis","author":"Wanke","year":"2024"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"100506","DOI":"10.1016\/j.puhip.2024.100506","article-title":"The global prevalence of E-cigarettes in youth: a comprehensive systematic review and meta-analysis","volume":"7","author":"Salari","year":"2024","journal-title":"Public Health Pract"},{"key":"ref28","year":"2016"},{"key":"ref29","volume-title":"Stata Statistical Software: Release 17","year":"2021"},{"key":"ref30","volume-title":"Regression models for categorical dependent variables using Stata","author":"Long","year":"2006"},{"key":"ref31","volume-title":"Statistical analysis with missing data","author":"Little","year":"2020"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1177\/00333549221138856","article-title":"Effect of COVID-19 lockdown on substance use among middle school and high school students: a natural experiment","volume":"138","author":"Noel","year":"2022","journal-title":"Public Health Rep"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"84","DOI":"10.15585\/mmwr.su7201a10","article-title":"Alcohol and other substance use before and during the COVID-19 pandemic among high school students \u2014 youth risk behavior survey, United States, 2021","volume":"72","author":"Hoots","year":"2023","journal-title":"MMWR Suppl"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1097\/ADT.0000000000000274","article-title":"Use of electronic nicotine delivery systems (ENDS) in Colombia","volume":"20","author":"Scoppetta","year":"2021","journal-title":"Addict Disord Their Treat"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.15585\/mmwr.mm7244a1","article-title":"Tobacco product use among U.S. middle and high school students \u2014 national youth tobacco survey, 2023","volume":"72","author":"Birdsey","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref36","first-page":"16","article-title":"Consumo de cigarrillos electr\u00f3nicos en Argentina: Resultados de dos encuestas nacionales","volume":"12","author":"Morello","year":"2020","journal-title":"Rev Argent Salud Publica"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"37","DOI":"10.4415\/ANN_23_01_06","article-title":"Should I give kids money? The role of pocket money on at-risk behaviors in Italian adolescents","volume":"59","author":"Lozza","year":"2023","journal-title":"Ann Ist Super Sanita"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1080\/09687630600832641","article-title":"The cost of drug use in adolescence: young people, money and substance abuse","volume":"14","author":"McCrystal","year":"2007","journal-title":"Drugs Educ Prev Policy"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"2248","DOI":"10.1111\/add.13930","article-title":"The association between personal income and smoking among adolescents: a study in six European cities","volume":"112","author":"Perelman","year":"2017","journal-title":"Addiction"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1046\/j.1360-0443.2002.00091.x","article-title":"Adolescent part-time work and heavy drinking in Finland","volume":"97","author":"Kouvonen","year":"2002","journal-title":"Addiction"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"281","DOI":"10.2307\/3340678","article-title":"Part-time work and deviance among high-school seniors","volume":"16","author":"Tanner","year":"1991","journal-title":"Can J Sociol"},{"key":"ref42","volume-title":"Guiding good choices: a program for parents of children ages 9\u201314","author":"Hawkins","year":"2004"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"41","DOI":"10.15288\/jsad.2010.71.41","article-title":"Alcohol use and heavy episodic drinking prevalence and predictors among national samples of American eighth- and tenth-grade students","volume":"71","author":"Patrick","year":"2010","journal-title":"J Stud Alcohol Drugs"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1111\/j.1530-0277.2007.00583.x","article-title":"Parenting mechanisms in links between parents\u2019 and adolescents\u2019 alcohol use Behaviors","volume":"32","author":"Latendresse","year":"2008","journal-title":"Alcohol Clin Exp Res"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1111\/add.16127","article-title":"The association between maternal and paternal substance use and child substance use, internalizing and externalizing problems: a systematic review and meta-analysis","volume":"118","author":"McGovern","year":"2023","journal-title":"Addiction"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"05","DOI":"10.18332\/tid\/84864","article-title":"Smoking by family members and friends and electronic-cigarette use in adolescence: a systematic review and meta-analysis","volume":"16","author":"Wang","year":"2018","journal-title":"Tob Induc Dis"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.ypmed.2010.05.001","article-title":"Adolescent substance use, parental monitoring, and leisure-time activities: 12-year outcomes of primary prevention in Iceland","volume":"51","author":"Kristjansson","year":"2010","journal-title":"Prev Med"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"11579","DOI":"10.3389\/fpsyt.2020.611579","article-title":"Associations of substance use behaviors with suicidal ideation and suicide attempts among US and Chinese adolescents","volume":"11","author":"Guo","year":"2021","journal-title":"Front Psych"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1177\/10105395221115220","article-title":"Perceived loneliness, peer, and parental relationship with smoking: a cross-sectional analysis of adolescents across South-East Asia","volume":"34","author":"McClure-Thomas","year":"2022","journal-title":"Asia Pac J Public Health"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1080\/13548506.2021.1883071","article-title":"Loneliness is associated with poor mental health, social-environmental factors, and health risk behaviours among national samples of in-school adolescents in four Caribbean countries","volume":"27","author":"Pengpid","year":"2022","journal-title":"Psychol Health Med"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"e0251099","DOI":"10.1371\/journal.pone.0251099","article-title":"Self-reported history of intensity of smoking is associated with risk factors for suicide among high school students","volume":"16","author":"Dasagi","year":"2021","journal-title":"PLoS One"},{"key":"ref52","first-page":"538","article-title":"Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents","volume":"35","author":"Angold","year":"2015","journal-title":"J Early Adolesc"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1177\/0272431614540526","article-title":"Relationships between substance use and depressive symptoms: a longitudinal study of Australian adolescents","volume":"5","author":"Scholes-Balog","year":"1995","journal-title":"Int J Methods Psychiatr Res"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1186\/s12888-024-06012-7","article-title":"Association of electronic cigarette use and suicidal behaviors: a systematic review and meta-analysis","volume":"24","author":"Awad","year":"2024","journal-title":"BMC Psychiatry"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"1516135","DOI":"10.3389\/fpubh.2025.1516135","article-title":"Associations between interpersonal violence and cigarette smoking, e-cigarette use, and dual use among Mexican adolescent students","volume":"13","author":"Rodr\u00edguez-Bola\u00f1os","year":"2025","journal-title":"Front Public Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1655355\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T05:44:28Z","timestamp":1758087868000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1655355\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,17]]},"references-count":55,"alternative-id":["10.3389\/fpubh.2025.1655355"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1655355","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,17]]},"article-number":"1655355"}}