Assessment of Substance use among adolescents residing in urban and rural areas of Gedeo Zone, Southern Ethiopia: A Comparative Cross-Sectional Study

Background: Evidence from various studies indicates that the initiation and early stages of substance use often begin in adolescence. However, less research has focused on the differences in substance use levels and determinants across distinct social contexts, particularly between urban and rural areas. This study aims to comparatively assess substance use and associated factors among adolescents in urban and rural areas of Gedeo Zone, Southern Ethiopia. Method: A community-based comparative cross-sectional study was conducted among 2,446 adolescents. The characteristics of respondents, including substance use patterns, were compared between urban and rural adolescents. Data were collected using a structured questionnaire and analyzed with SPSS version 24. Multivariate binary logistic regression analysis was employed to identify factors associated with substance use, using a significance level of p < 0.05. Results: The overall prevalence of substance use among adolescents in this study was 23.3%, with 20.1% among urban adolescents and 26.5% among rural adolescents, indicating a statistically significant difference between the two groups. Parental substance use and having peers who use substances increased the risk of substance use, while an unfavorable attitude toward substance use decreased this risk among both urban and rural adolescents. Additionally, urban adolescents with poor parental control were more likely to engage in substance use. Conclusion: The level of substance use among adolescents in this study is moderately high. Factors such as peer and parental substance use, attitudes toward substance use, and adolescents’ occupations were significantly associated with substance use.