Substance use, suicidality and sexual activity among secondary school adolescents from Bhutan and Nepal

Alcohol, tobacco and cannabis use, early sexual debut and suicidality among young people are public health issues. This study sought to explore associations between health-risk behaviours (use of alcohol, tobacco and cannabis, mental health and suicidality) and protective factors among in-school Himalayan secondary students from Bhutan and Nepal. Secondary analyses of WHO Global School Health Survey data obtained from the cross-sectional surveys of in-school Himalayan secondary students from Bhutan (2016, n = 7576) and Nepal (2015, n = 6529). Findings showed a concerning level of suicidality in both countries, early commencement of alcohol use, higher prevalence of current cannabis and alcohol use in Bhutan, and low condom use overall. Preventive health activities that target students at younger ages, males in particular, need strengthening, as do risk reduction efforts to delay onset of substance use and sexual debut and strategies to increase protective factors such as retention and participation in education.