Protective factors, coping mechanisms and social engagement associated with current substance use among adolescents from 108 schools in India: a multicentre cross-sectional study

Substance use during adolescence is an important public health concern with potential consequences for health and well-being. Although previous research has predominantly focused on risk factors, evidence on psychosocial resources associated with adolescent substance use remains limited, particularly in low- and middle-income countries. We examined the associations of protective factors, coping mechanisms, and social engagement with current substance use among school-going adolescents in India. We conducted a multicentre cross-sectional analysis of baseline data from 6,168 adolescents aged 10–19 years enrolled in 108 schools across six geographically diverse settings in India. Self-reported current substance use, defined as the use of at least one assessed psychoactive substance during the preceding three months, was the primary outcome. Study-specific composite scores for protective factors, coping mechanisms, and social engagement were constructed from questionnaire items included in the parent multicentre study and categorized as low, moderate, or high using interquartile range-based cut-offs. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs), adjusting for age, sex, household economic status, living arrangement, pocket money, peer norms, and study site. Separate adjusted ordinal analyses assessed overall trends across increasing categories of the psychosocial measures, and exploratory interaction analyses examined potential effect modification by peer norms. Current substance-use information was available for 4,848 of 6,168 adolescents (78.6%), of whom 545 (11.2%) reported current substance use. Compared with adolescents with low protective-factor scores, those with moderate scores had lower odds of current substance use (AOR 0.60, 95% CI 0.47–0.76), whereas the estimate for high scores was weaker and less precise (AOR 0.78, 95% CI 0.59–1.02). Similarly, moderate coping scores were associated with lower odds of current substance use (AOR 0.65, 95% CI 0.51–0.82), while the estimate for high coping scores was weaker and less precise (AOR 0.81, 95% CI 0.60–1.10). For social engagement, the moderate category showed little evidence of an independent association (AOR 0.98, 95% CI 0.77–1.25), while the estimate for high social engagement was imprecise (AOR 2.27, 95% CI 0.71–7.24). Exploratory interaction analyses provided limited evidence of effect modification by peer norms. Moderate levels of protective factors and coping mechanisms were associated with lower odds of current substance use among school-going adolescents, whereas the corresponding high-category estimates were weaker and less precise. Categorical analyses provided limited evidence of an independent association between social engagement and current substance use. Adjusted ordinal analyses indicated overall inverse ordinal trends across increasing categories of the psychosocial measures; however, the category-specific estimates did not consistently demonstrate monotonic patterns and therefore should not be interpreted as evidence of dose-response relationships. These cross-sectional findings identify psychosocial characteristics potentially relevant to adolescent health programmes but do not establish temporality or causal effects. Longitudinal studies using validated psychosocial measures are needed to clarify these associations.