Prevalence and correlates of substance use among middle and high school students in Settat Province, Morocco

BACKGROUND: Adolescent substance use poses significant public health challenges, yet data in Morocco are scarce. This study investigates the prevalence and associated factors of cigarette, alcohol, and cannabis use among students in Settat Province. METHODS: A cross-sectional survey of 320 middle and high school students (aged 12–20) was conducted from December 2023 to May 2024 in urban and rural areas. Substance use was assessed using ADOSPA, CAST, and Fagerström tests. Chi-square tests analyzed associations (p ≤ 0.05). RESULTS: Substance use was significantly associated with male gender, age 18 years and older, urban residence, and having substance-using peers (p < 0.0001). Among key substance use behaviors, 51.5% of students reported early-morning smoking, 28.4% reported alcohol use to relax or feel better, and 3.7% reported cannabis use before midday in the past 12 months. CONCLUSION: Substance use was significantly related to Sociodemographic characteristics and peer influence. Tailored interventions are essential to reduce high-risk behaviors and nicotine dependence among adolescents.