Understanding substance use and public health dimensions among tribal youth in Ladakh, India, through a qualitative social ecological approach

Abstract Substance use is a new social and public health issue in Ladakh (India), a territory with a distinctive geographical, cultural, and social profile. This qualitative research seeks to explore the sociocultural, psychological, and structural determinants of substance use in Ladakh (India), thus addressing an important lacuna in region-specific empirical work. Drawing on the Social-Ecological Model (SEM), the present research explores the multidimensionality of substance use by investigating individual, interpersonal, community, and societal drivers. Data were collected through in-depth interviews (IDIs) and focus group discussions (FGDs) with local people, young people, stakeholders, health service providers, police officers, and non-governmental organization experts. Thematic analysis guided by the Braun and Clarke (2006) guidelines was used to determine themes and sub-themes, with systematic coding facilitated through NVivo 14 software. The research concludes that the intricate dynamics of peer pressure, family pressure, cultural pressure, economic insecurity, easy availability of substances, and psychological vulnerabilities are the major drivers behind substance use by the youth of Ladakh. Disintegration of traditional values, media exposure, and unemployment are also contributing factors that worsen the situation. The research emphasizes community-based prevention interventions, enhanced social-emotional learning in schools, and culturally appropriate substance use awareness campaigns. The findings enhance our understanding of the situation and provide a basis for policymakers and stakeholders to formulate effective, context-sensitive prevention and rehabilitation interventions in culturally diverse regions.